Provider Demographics
NPI:1043415573
Name:SHIPMAN, MARILYN J (T-LMSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:T-LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 N PORTER AVE
Mailing Address - Street 2:#A20
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2215
Mailing Address - Country:US
Mailing Address - Phone:620-757-8734
Mailing Address - Fax:
Practice Address - Street 1:337 N PINE ST
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-1856
Practice Address - Country:US
Practice Address - Phone:620-672-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6657104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker