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NPI Code Detail

MEDICARE: JEANNE ERIKSON LSCSW

MEDICARE:   JEANNE  ERIKSON  LSCSW
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
1101YM0800XMental Health Counselor1633KS

General Provider Information

NPI Number : 1063512739
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNE ERIKSON LSCSW
Provider Business Mailing Address
First Line : 200 W DOUGLAS AVE
Second Line : STE 555
City : WICHITA
State : KS
Zip : 67202-3007
Country : US
Telephone Number : 316-776-2317
Fax Number : 833-377-0520
Provider Business Practice Location Address
First Line : 200 W DOUGLAS AVE STE 560
Second Line :
City : WICHITA
State : KS
Zip : 67202-3020
Country : US
Telephone Number : 316-269-2322
Fax Number : 316-269-2448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2006
Last Update Date : 06/16/2020

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Directions to “ JEANNE ERIKSON LSCSW” Practice Location

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