MEDICARE: BREANA TUCKER LMSW

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
1	104100000X	Social Worker	9584	KS

General Provider Information

NPI Number	:	1841971207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANA TUCKER LMSW

Provider Business Mailing Address
First Line	:	10541 SONDRA CT
Second Line	:
City	:	MAIZE
State	:	KS
Zip	:	67101-4122
Country	:	US
Telephone Number	:	316-648-7259
Fax Number	:

Provider Business Practice Location Address
First Line	:	8080 E CENTRAL AVE STE 320
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2389
Country	:	US
Telephone Number	:	316-927-3010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	07/28/2023

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Directions to “ BREANA TUCKER LMSW” Practice Location

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