Healthcare Provider Details

I. General information

NPI: 1316243090
Provider Name (Legal Business Name): DEDRA L GLENNEMEIER LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SW 3RD ST UNIT 1A
TOPEKA KS
66606-2438
US

IV. Provider business mailing address

2601 SW 3RD ST UNIT 1A
TOPEKA KS
66606-2438
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-4630
  • Fax: 785-270-4628
Mailing address:
  • Phone: 785-270-4630
  • Fax: 785-270-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2546
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberT-LMLP 2467
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: