Provider Demographics
NPI:1003541558
Name:MEADOR, EMILY MICHELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MICHELLE
Last Name:MEADOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 S VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-5248
Mailing Address - Country:US
Mailing Address - Phone:316-223-5223
Mailing Address - Fax:
Practice Address - Street 1:11828 W CENTRAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5178
Practice Address - Country:US
Practice Address - Phone:316-613-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12730104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12730OtherMASTER'S SOCIAL WORK LICENSE NUMBER