Healthcare Provider Details

I. General information

NPI: 1992628580
Provider Name (Legal Business Name): KAW VALLEY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 NEW JERSEY ST
LAWRENCE KS
66044-2741
US

IV. Provider business mailing address

715 NEW JERSEY ST
LAWRENCE KS
66044-2741
US

V. Phone/Fax

Practice location:
  • Phone: 785-842-3797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BAILEY WILSON
Title or Position: OWNER
Credential: LSCSW
Phone: 785-251-3032