Provider Demographics
NPI:1063469310
Name:KRISS, LINDA A (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:A
Last Name:KRISS
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 1:4504 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3587
Mailing Address - Country:US
Mailing Address - Phone:785-832-8603
Mailing Address - Fax:
Practice Address - Street 1:4504 HARVARD RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3587
Practice Address - Country:US
Practice Address - Phone:785-832-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 17701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000041177OtherBLUE CROSS/BLUE SHIELD
KS8885680001Medicaid