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General NPI Number Information
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NPI Number | 1396494456
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Entity Type | Individual
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Provider Name | JOHN ROBERT DEHAVEN
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Gender | Male
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 101 E CEDAR ST
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City | OLATHE
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State | KS
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Zip | 66061-4416
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Country | US
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Telephone | 913-393-3828
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Fax |
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Provider Business Mailing Address
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Address Line | 1199 E SANTA FE ST LOT 309
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City | GARDNER
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State | KS
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Zip | 66030-1546
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Country | US
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Telephone | 785-342-6622
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5259
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License Number State | KS
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