Healthcare Provider Details

I. General information

NPI: 1427584929
Provider Name (Legal Business Name): LAURA GAWECKI LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LIMIT ST
LEAVENWORTH KS
66048-4435
US

IV. Provider business mailing address

500 LIMIT ST
LEAVENWORTH KS
66048-4435
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-5118
  • Fax: 913-682-4664
Mailing address:
  • Phone: 913-682-5118
  • Fax: 913-682-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number2767
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: