Healthcare Provider Details

I. General information

NPI: 1053919787
Provider Name (Legal Business Name): MEGAN A. ELLIOTT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N RIDGE RD
WICHITA KS
67212-3323
US

IV. Provider business mailing address

1713 E WINDWOOD CT
DERBY KS
67037-3952
US

V. Phone/Fax

Practice location:
  • Phone: 316-409-0565
  • Fax:
Mailing address:
  • Phone: 316-871-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07203
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: