Healthcare Provider Details

I. General information

NPI: 1720582927
Provider Name (Legal Business Name): LAUREN R CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N OLIVER ST
WICHITA KS
67220-2106
US

IV. Provider business mailing address

3223 N OLIVER ST
WICHITA KS
67220-2106
US

V. Phone/Fax

Practice location:
  • Phone: 316-267-5437
  • Fax: 316-267-5444
Mailing address:
  • Phone: 316-267-5437
  • Fax: 316-267-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: