=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457704223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEE ANN BATT, MS, LSCSW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2016
-----------------------------------------------------
Last Update Date | 07/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2548 N MAIZE CT SUITE 102
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67205-7347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-789-6368
-----------------------------------------------------
Fax | 316-789-6349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10808 W SHADE LN
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67212-5913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-249-3226
-----------------------------------------------------
Fax | 316-789-6349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEE ANN BATT CAMPBELL
-----------------------------------------------------
Credential | MS, LSCSW
-----------------------------------------------------
Telephone | 316-789-6368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 4447
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------