Healthcare Provider Details

I. General information

NPI: 1740632470
Provider Name (Legal Business Name): MEGAN SMITH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN BOLLINGER

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WAKARUSA DR STE E2106
LAWRENCE KS
66049-4722
US

IV. Provider business mailing address

313 FORT LARAMIE DR
LAWRENCE KS
66049-4904
US

V. Phone/Fax

Practice location:
  • Phone: 620-794-1339
  • Fax:
Mailing address:
  • Phone: 620-794-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10063
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07173
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: