Healthcare Provider Details

I. General information

NPI: 1881225464
Provider Name (Legal Business Name): CAITLIN WYER LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N ROCK RD STE 355
WICHITA KS
67206-2275
US

IV. Provider business mailing address

240 N ROCK RD STE 355
WICHITA KS
67206-2275
US

V. Phone/Fax

Practice location:
  • Phone: 316-217-8025
  • Fax:
Mailing address:
  • Phone: 316-217-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10404
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06322
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: