Provider Demographics
NPI:1023213303
Name:PONCE, CECILIA (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MRS
Other - First Name:CECILIA
Other - Middle Name:
Other - Last Name:OWSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:407 S CLAIRBORNE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1744
Mailing Address - Country:US
Mailing Address - Phone:913-468-2266
Mailing Address - Fax:
Practice Address - Street 1:407 S CLAIRBORNE RD STE 104
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1744
Practice Address - Country:US
Practice Address - Phone:913-468-2266
Practice Address - Fax:913-788-4203
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
KS39801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098080COtherSED WAIVER
KS100098080AMedicaid
KS100098080AMedicaid