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NPI Code Detail

MEDICARE: KALYN KELLEY BOESEN LMSW-T

MEDICARE: KALYN KELLEY BOESEN LMSW-T
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianKS
2104100000XSocial Worker14115-TKS

General Provider Information

NPI Number : 1194347559
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALYN KELLEY BOESEN LMSW-T
Provider Business Mailing Address
First Line : PO BOX 1135
Second Line :
City : WICHITA
State : KS
Zip : 67201-1135
Country : US
Telephone Number : 316-680-8283
Fax Number :
Provider Business Practice Location Address
First Line : 345 N RIVERVIEW ST STE 730
Second Line :
City : WICHITA
State : KS
Zip : 67203-4267
Country : US
Telephone Number : 316-680-8283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2020
Last Update Date : 07/03/2025

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