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General NPI Number Information
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NPI Number | 1336379130
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Entity Type | Individual
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Provider Name | ELOISE J PANKRATZ LSCSW
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Gender | Female
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 240 N ROCK RD STE 228
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City | WICHITA
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State | KS
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Zip | 67206-2245
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Country | US
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Telephone | 316-351-8029
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Fax | 316-776-4547
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Provider Business Mailing Address
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Address Line | 1143 S. GOVERNEOUR RD
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City | WICHITA
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State | KS
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Zip | 67207
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Country | US
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Telephone | 316-772-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7357
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4665
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License Number State | KS
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