Healthcare Provider Details

I. General information

NPI: 1851949986
Provider Name (Legal Business Name): LORENA LETICIA GONZALEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 SW 36TH ST
TOPEKA KS
66614-3528
US

IV. Provider business mailing address

3455 SW BURLINGAME RD APT C
TOPEKA KS
66611-2089
US

V. Phone/Fax

Practice location:
  • Phone: 785-408-9512
  • Fax:
Mailing address:
  • Phone: 785-408-9512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11423
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: