Healthcare Provider Details

I. General information

NPI: 1326770843
Provider Name (Legal Business Name): CORBIN GOSNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 E LINCOLN ST
WICHITA KS
67218-2008
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12618
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: