Healthcare Provider Details

I. General information

NPI: 1285114876
Provider Name (Legal Business Name): CONNOR BLAKE WYCKOFF LSCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SW JACKSON ST STE 618 #528
TOPEKA KS
66612
US

IV. Provider business mailing address

800 SW JACKSON ST STE 618 #528
TOPEKA KS
66612
US

V. Phone/Fax

Practice location:
  • Phone: 785-414-9911
  • Fax: 785-414-5228
Mailing address:
  • Phone: 785-414-9911
  • Fax: 785-414-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05342
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10930
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: