Provider Demographics
NPI:1043466923
Name:WHALEN, VANESSA LEIGH (LSCSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEIGH
Last Name:WHALEN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ROCK RD STE 340
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2263
Mailing Address - Country:US
Mailing Address - Phone:316-729-9965
Mailing Address - Fax:
Practice Address - Street 1:250 N ROCK RD STE 340
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2263
Practice Address - Country:US
Practice Address - Phone:316-729-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical