Healthcare Provider Details

I. General information

NPI: 1265883664
Provider Name (Legal Business Name): SASHA DILLINGHAM LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 STATE ST
FORT SCOTT KS
66701-2031
US

IV. Provider business mailing address

304 N JEFFERSON AVE
IOLA KS
66749-2327
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-5030
  • Fax:
Mailing address:
  • Phone: 620-365-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06478
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: