Provider Demographics
NPI:1255694055
Name:WILKENING, LYNETTE RENEE (LSCSW)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:RENEE
Last Name:WILKENING
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 1:1625 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1226
Mailing Address - Country:US
Mailing Address - Phone:888-878-6881
Mailing Address - Fax:620-728-0823
Practice Address - Street 1:1625 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1226
Practice Address - Country:US
Practice Address - Phone:888-878-6881
Practice Address - Fax:620-728-0823
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS48201041C0700X
KS8412104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker