Provider Demographics
NPI:1326744301
Name:NEURODIVERGENT CONSULTANTS OF KANSAS
Entity Type:Organization
Organization Name:NEURODIVERGENT CONSULTANTS OF KANSAS
Other - Org Name:NEURODIVERGENT CONSULTANTS OF KANSAS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:316-773-8937
Mailing Address - Street 1:2442 N BELLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1417
Mailing Address - Country:US
Mailing Address - Phone:316-773-8937
Mailing Address - Fax:316-202-5180
Practice Address - Street 1:423 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5964
Practice Address - Country:US
Practice Address - Phone:316-773-8937
Practice Address - Fax:316-202-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental DisabilitiesGroup - Single Specialty