=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205455540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE LAYNE PROJECT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2020
-----------------------------------------------------
Last Update Date | 04/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 N CHESTNUT ST
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-829-3711
-----------------------------------------------------
Fax | 913-829-8858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 N CHESTNUT ST
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-829-3711
-----------------------------------------------------
Fax | 913-829-8858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TRINA A. NUDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-829-3711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------