Healthcare Provider Details

I. General information

NPI: 1851498653
Provider Name (Legal Business Name): MICHELE VANWINKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DONALD AVE
INDEPENDENCE KS
67301-2001
US

IV. Provider business mailing address

PO BOX 688
INDEPENDENCE KS
67301-0688
US

V. Phone/Fax

Practice location:
  • Phone: 620-331-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC 1029
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4983
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: