Healthcare Provider Details

I. General information

NPI: 1295408144
Provider Name (Legal Business Name): REBECCA LYNN ESPARZA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 HASKELL AVE
LAWRENCE KS
66044-3565
US

IV. Provider business mailing address

1905 E 17TH ST
LAWRENCE KS
66044-3595
US

V. Phone/Fax

Practice location:
  • Phone: 785-246-9490
  • Fax:
Mailing address:
  • Phone: 785-917-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10712
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: