Healthcare Provider Details

I. General information

NPI: 1922838655
Provider Name (Legal Business Name): STEPHANIE VOTH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE WALL

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 COMMERCE DR
HESSTON KS
67062-8938
US

IV. Provider business mailing address

10724 SW 72ND ST
HALSTEAD KS
67056-9372
US

V. Phone/Fax

Practice location:
  • Phone: 620-869-9986
  • Fax:
Mailing address:
  • Phone: 316-804-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13823
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: