Healthcare Provider Details

I. General information

NPI: 1912189853
Provider Name (Legal Business Name): AMANDA MARIE COONROD LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 MAINE ST STE D
LAWRENCE KS
66044-2263
US

IV. Provider business mailing address

346 MAINE ST STE D
LAWRENCE KS
66044-2263
US

V. Phone/Fax

Practice location:
  • Phone: 785-243-6310
  • Fax:
Mailing address:
  • Phone: 785-243-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4398
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: