Healthcare Provider Details

I. General information

NPI: 1851034607
Provider Name (Legal Business Name): CHRISTIE CALDERON LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIE CONNELL

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E SPRUCE ST
GARDEN CITY KS
67846-5958
US

IV. Provider business mailing address

PO BOX 1905
GARDEN CITY KS
67846-1905
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-0644
  • Fax: 620-276-7689
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07372
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: