Provider Demographics
NPI:1023014172
Name:STONESTREET, JERI DIANNE (LSCW)
Entity Type:Individual
Prefix:MS
First Name:JERI
Middle Name:DIANNE
Last Name:STONESTREET
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5847 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2462
Mailing Address - Country:US
Mailing Address - Phone:785-273-7292
Mailing Address - Fax:785-273-1201
Practice Address - Street 1:5847 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2462
Practice Address - Country:US
Practice Address - Phone:785-273-7292
Practice Address - Fax:785-273-1201
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS-LSCW #8081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS011482Medicare ID - Type Unspecified