Provider Demographics
NPI:1225274202
Name:BROZ, VICKI M (LMSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:M
Last Name:BROZ
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 1:2101 US HIGHWAY 50 BYP
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2230
Mailing Address - Country:US
Mailing Address - Phone:620-227-8566
Mailing Address - Fax:620-225-5824
Practice Address - Street 1:2101 US HIGHWAY 50 BYP
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2230
Practice Address - Country:US
Practice Address - Phone:620-227-8566
Practice Address - Fax:620-225-5824
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7342104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker