MEDICARE: MS. KAREN MAUREEN DULLEA MSW 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	LSCSW405	KS

General Provider Information

NPI Number	:	1578642294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN MAUREEN DULLEA MSW LSCSW

Provider Business Mailing Address
First Line	:	2024 NORTH WOODLAWN
Second Line	:	SUITE 411
City	:	WICHITA
State	:	KS
Zip	:	67208-1879
Country	:	US
Telephone Number	:	316-684-2741
Fax Number	:	316-684-9261

Provider Business Practice Location Address
First Line	:	2024 NORTH WOODLAWN
Second Line	:	SUITE 411
City	:	WICHITA
State	:	KS
Zip	:	67208-1879
Country	:	US
Telephone Number	:	316-684-2741
Fax Number	:	316-684-9261

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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