Healthcare Provider Details

I. General information

NPI: 1194106302
Provider Name (Legal Business Name): AMANDA MAUPIN LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8533 E 32ND ST N
WICHITA KS
67226-2611
US

IV. Provider business mailing address

635 N MAIN ST
WICHITA KS
67203-3602
US

V. Phone/Fax

Practice location:
  • Phone: 316-293-2622
  • Fax: 855-517-9494
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-941-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9605
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4902
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: