MEDICARE: DR. ALICIA M LANDSVERK PHD, LSCSW

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	1041C0700X	Clinical Social Worker	1527	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972507457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA M LANDSVERK PHD, LSCSW

Provider Business Mailing Address
First Line	:	1721 E OSAGE RD STE 300
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-2290
Country	:	US
Telephone Number	:	316-788-1907
Fax Number	:	316-788-1941

Provider Business Practice Location Address
First Line	:	1721 E OSAGE RD
Second Line	:	STE 300
City	:	DERBY
State	:	KS
Zip	:	67037-2092
Country	:	US
Telephone Number	:	316-788-1907
Fax Number	:	316-788-1941

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/20/2011

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