MEDICARE: GLORIA HEGGE

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	1925	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14261948	OTHER	KS	CAQH

General Provider Information

NPI Number	:	1073004941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA HEGGE

Provider Business Mailing Address
First Line	:	313 S MARKET ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67202-3805
Country	:	US
Telephone Number	:	316-265-9441
Fax Number	:	316-265-6066

Provider Business Practice Location Address
First Line	:	9415 E HARRY ST STE 800
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67207-5084
Country	:	US
Telephone Number	:	316-652-2590
Fax Number	:	316-685-0768

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

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	05/25/2018

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Directions to “ GLORIA HEGGE ” Practice Location

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