Healthcare Provider Details

I. General information

NPI: 1538063532
Provider Name (Legal Business Name): LAURA J ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E 18TH ST N
WICHITA KS
67214-2114
US

IV. Provider business mailing address

2500 E 18TH ST N
WICHITA KS
67214-2114
US

V. Phone/Fax

Practice location:
  • Phone: 316-973-8300
  • Fax:
Mailing address:
  • Phone: 316-973-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number9317
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: