MEDICARE: ZOE THEOBALD 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	1041C0700X	Clinical Social Worker	13147	KS

General Provider Information

NPI Number	:	1699451336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE THEOBALD LMSW

Provider Business Mailing Address
First Line	:	2721 W 6TH ST STE B
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4302
Country	:	US
Telephone Number	:	515-577-6231
Fax Number	:

Provider Business Practice Location Address
First Line	:	2721 W 6TH ST STE B
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4302
Country	:	US
Telephone Number	:	515-577-6231
Fax Number	:

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

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	02/02/2026

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Directions to “ ZOE THEOBALD LMSW” Practice Location

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