Healthcare Provider Details

I. General information

NPI: 1245995679
Provider Name (Legal Business Name): BRITTNI R SILLS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21522 SW TAWAKONI RD
DOUGLASS KS
67039-8114
US

IV. Provider business mailing address

21522 SW TAWAKONI RD
DOUGLASS KS
67039-8114
US

V. Phone/Fax

Practice location:
  • Phone: 316-644-2101
  • Fax:
Mailing address:
  • Phone: 316-644-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0009923892
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number7904
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: