Healthcare Provider Details

I. General information

NPI: 1689235400
Provider Name (Legal Business Name): ARYN NICOLE ANDERSEN LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARYN SCHOWENGERDT

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E WINKLER ST
WATERVILLE KS
66548-9103
US

IV. Provider business mailing address

112 E WINKLER ST
WATERVILLE KS
66548-9103
US

V. Phone/Fax

Practice location:
  • Phone: 620-255-6041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11339
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930718
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05722
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113942
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW125639
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: