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General NPI Number Information
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NPI Number | 1356086169
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Entity Type | Individual
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Provider Name | JOANNA LEE SHORT LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 530 N RIDGE RD STE B
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City | WICHITA
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State | KS
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Zip | 67212-6576
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Country | US
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Telephone | 316-616-1055
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Fax | 855-633-0585
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Provider Business Mailing Address
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Address Line | 101 W HEFNER RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-6631
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Country | US
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Telephone | 405-896-8058
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Fax | 855-223-1999
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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 | LMSW7911
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License Number State | KS
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