Provider Demographics
NPI:1033111281
Name:SKINNER, BETTY KEPLER (LSCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:KEPLER
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LSCSW, ACSW
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:K
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW, ACSW
Mailing Address - Street 1:2135 N SUNRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1503
Mailing Address - Country:US
Mailing Address - Phone:316-201-1080
Mailing Address - Fax:316-201-1085
Practice Address - Street 1:2135 N SUNRIDGE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1503
Practice Address - Country:US
Practice Address - Phone:316-201-1080
Practice Address - Fax:316-201-1085
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW #8061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200003060/CMedicaid
KS200003060/CMedicaid