Healthcare Provider Details

I. General information

NPI: 1962601013
Provider Name (Legal Business Name): SARAH A HALDEMAN-SMITH LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 S ROCK RD STE 110
WICHITA KS
67210-1857
US

IV. Provider business mailing address

1528 W HANEY SOUTH CT
ANDOVER KS
67002-7910
US

V. Phone/Fax

Practice location:
  • Phone: 316-215-9359
  • Fax: 855-871-5714
Mailing address:
  • Phone: 316-215-9359
  • Fax: 855-871-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6337
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05622
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: