Healthcare Provider Details

I. General information

NPI: 1528351004
Provider Name (Legal Business Name): JACQUELINE M HAMILTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 SW 29TH ST
TOPEKA KS
66611-1105
US

IV. Provider business mailing address

21350 W 153RD ST
OLATHE KS
66061-5413
US

V. Phone/Fax

Practice location:
  • Phone: 913-499-8100
  • Fax: 913-499-8111
Mailing address:
  • Phone: 913-499-8100
  • Fax: 913-499-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10275
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: