Healthcare Provider Details

I. General information

NPI: 1235046806
Provider Name (Legal Business Name): HANNAH ISABELLE PIROS JACKSON LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MAIN ST STE 505
WICHITA KS
67202-3738
US

IV. Provider business mailing address

100 S MAIN ST STE 505
WICHITA KS
67202-3738
US

V. Phone/Fax

Practice location:
  • Phone: 316-688-8390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03564
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: