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NPI Code Detail

MEDICARE: JACOB KRESKY LMSW

MEDICARE: JACOB KRESKY LMSW
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
1104100000XSocial Worker13644KS

General Provider Information

NPI Number : 1336985720
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB KRESKY LMSW
Provider Business Mailing Address
First Line : 3500 N ROCK RD BLDG 100
Second Line :
City : WICHITA
State : KS
Zip : 67226-1328
Country : US
Telephone Number : 316-239-2210
Fax Number : 316-239-2210
Provider Business Practice Location Address
First Line : 3500 N ROCK RD BLDG 100
Second Line :
City : WICHITA
State : KS
Zip : 67226-1328
Country : US
Telephone Number : 316-239-2210
Fax Number : 316-239-2210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2024
Last Update Date : 10/30/2025

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