Healthcare Provider Details

I. General information

NPI: 1285590901
Provider Name (Legal Business Name): OUTCOMES LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 N GLANCEY ST
ANDOVER KS
67002-7411
US

IV. Provider business mailing address

1430 N GLANCEY ST
ANDOVER KS
67002-7411
US

V. Phone/Fax

Practice location:
  • Phone: 316-258-1661
  • Fax:
Mailing address:
  • Phone: 316-258-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREW SMALL
Title or Position: VISION OFFICER
Credential: LMSW
Phone: 316-258-1661