MEDICARE: MS. BETTY KEPLER SKINNER LSCSW, ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LSCSW #806	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033111281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETTY KEPLER SKINNER LSCSW, ACSW

Provider Business Mailing Address
First Line	:	2135 N SUNRIDGE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67235-1503
Country	:	US
Telephone Number	:	316-201-1080
Fax Number	:	316-201-1085

Provider Business Practice Location Address
First Line	:	2135 N SUNRIDGE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67235-1503
Country	:	US
Telephone Number	:	316-201-1080
Fax Number	:	316-201-1085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/06/2013

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