Healthcare Provider Details

I. General information

NPI: 1588408611
Provider Name (Legal Business Name): EMILY MATTOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 N WOODLAWN BLVD BLDG 500
WICHITA KS
67220-3960
US

IV. Provider business mailing address

110 W OTIS AVE
SALINA KS
67401-8713
US

V. Phone/Fax

Practice location:
  • Phone: 785-825-0541
  • Fax:
Mailing address:
  • Phone: 785-825-0541
  • Fax: 785-825-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13408
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: