Healthcare Provider Details

I. General information

NPI: 1821441981
Provider Name (Legal Business Name): REGINA HAFNER-STOUT LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E 2ND ST N STE B
WICHITA KS
67202-2504
US

IV. Provider business mailing address

934 N WATER ST
WICHITA KS
67203-3838
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7800
  • Fax: 316-941-5060
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-941-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06239
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: