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General NPI Number Information
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NPI Number | 1881781359
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Entity Type | Individual
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Provider Name | WALTER J THIESSEN L.S.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 415 N POPLAR AVE
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City | WICHITA
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State | KS
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Zip | 67214-4529
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Country | US
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Telephone | 316-686-6671
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Fax | 316-686-1094
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Provider Business Mailing Address
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Address Line | 857 N COOLIDGE AVE
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City | WICHITA
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State | KS
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Zip | 67203-3115
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Country | US
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Telephone | 316-264-9903
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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 | 0785
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License Number State | KS
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