MEDICARE: AYRIKA WATSON 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
1	104100000X	Social Worker	11000	KS

General Provider Information

NPI Number	:	1578040606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYRIKA WATSON LMSW

Provider Business Mailing Address
First Line	:	201 E LAUREL ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5538
Country	:	US
Telephone Number	:	620-272-9506
Fax Number	:	620-272-9833

Provider Business Practice Location Address
First Line	:	201 E LAUREL ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5538
Country	:	US
Telephone Number	:	620-272-9506
Fax Number	:	620-272-9833

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

Provider Enumeration Date	:	07/21/2018
Last Update Date	:	07/21/2018

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