Healthcare Provider Details

I. General information

NPI: 1134789613
Provider Name (Legal Business Name): DEBRA L GALLAWAY LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA L SMITH

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31642 KEENE ESKRIDGE RD
MAPLE HILL KS
66507-8633
US

IV. Provider business mailing address

31642 KEENE ESKRIDGE RD
MAPLE HILL KS
66507-8633
US

V. Phone/Fax

Practice location:
  • Phone: 785-640-3676
  • Fax:
Mailing address:
  • Phone: 785-640-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1405
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: