Healthcare Provider Details

I. General information

NPI: 1053751677
Provider Name (Legal Business Name): HEATHER MCGANN LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 SW 6TH AVE
TOPEKA KS
66606-2084
US

IV. Provider business mailing address

1500 SW 10TH AVE MEDICAL STAFF SERVICES
TOPEKA KS
66604-1301
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-0602
  • Fax: 785-270-4602
Mailing address:
  • Phone: 785-354-6241
  • Fax: 785-270-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5055
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: