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NPI Code Detail

MEDICARE: STACEY BRENDMOEN LMSW

MEDICARE: STACEY BRENDMOEN 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 Worker5164KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1201506OTHERKSBLUE CROSS BLUE SHIELD
214794OTHERKSPREFERRED HEALTH SYSTEMS

General Provider Information

NPI Number : 1457390478
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY BRENDMOEN LMSW
Provider Business Mailing Address
First Line : 635 N MAIN ST
Second Line :
City : WICHITA
State : KS
Zip : 67203-3602
Country : US
Telephone Number : 316-660-7600
Fax Number : 316-383-7925
Provider Business Practice Location Address
First Line : 1938 N WOODLAWN ST STE 400
Second Line :
City : WICHITA
State : KS
Zip : 67208-1875
Country : US
Telephone Number : 316-660-9600
Fax Number : 316-660-9660
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 07/02/2025

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Directions to “ STACEY BRENDMOEN LMSW” Practice Location

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