Healthcare Provider Details

I. General information

NPI: 1003225574
Provider Name (Legal Business Name): STEPHANIE SHANELEC-KEELER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 N OLIVER AVE
WICHITA KS
67208-4000
US

IV. Provider business mailing address

635 N MAIN ST
WICHITA KS
67203-3602
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-1028
  • Fax: 316-660-1015
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-660-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9174
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: