Healthcare Provider Details

I. General information

NPI: 1790633071
Provider Name (Legal Business Name): KATHRYN FRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 W 31ST ST
LAWRENCE KS
66047-3042
US

IV. Provider business mailing address

3015 W 31ST ST
LAWRENCE KS
66047-3042
US

V. Phone/Fax

Practice location:
  • Phone: 785-312-8255
  • Fax:
Mailing address:
  • Phone: 785-312-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01345
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: