Provider Demographics
NPI:1033724596
Name:BOTKIN, REGAN SUE ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:SUE ANN
Last Name:BOTKIN
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 1:1219 RED WHEAT DR
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-7994
Mailing Address - Country:US
Mailing Address - Phone:620-228-3513
Mailing Address - Fax:
Practice Address - Street 1:618 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-3969
Practice Address - Country:US
Practice Address - Phone:620-794-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11738104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker