Provider Demographics
NPI:1093813628
Name:KOFRON, EMILY E (MSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:E
Last Name:KOFRON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MASSACHUSETTS ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2868
Mailing Address - Country:US
Mailing Address - Phone:785-842-8100
Mailing Address - Fax:785-865-0014
Practice Address - Street 1:900 MASSACHUSETTS ST
Practice Address - Street 2:SUITE 408
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2868
Practice Address - Country:US
Practice Address - Phone:785-842-8100
Practice Address - Fax:785-865-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15571041C0700X
KS403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS44788Medicare ID - Type Unspecified