MEDICARE: LURA L BORSDORF 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
1	1041C0700X	Clinical Social Worker	3581	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	:	1144314352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LURA L BORSDORF LSCSW

Provider Business Mailing Address
First Line	:	3001 CORNELISON ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2032
Country	:	US
Telephone Number	:	316-200-6820
Fax Number	:	888-648-8640

Provider Business Practice Location Address
First Line	:	403 W CENTRAL AVE STE A
Second Line	:
City	:	ANDOVER
State	:	KS
Zip	:	67002-9614
Country	:	US
Telephone Number	:	316-200-6820
Fax Number	:	888-648-8640

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/18/2009

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