Provider Demographics
NPI:1396029997
Name:NIEDFELDT, STEPHANI LUCILE (LSCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:LUCILE
Last Name:NIEDFELDT
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 1:6002 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-3156
Mailing Address - Country:US
Mailing Address - Phone:785-410-4937
Mailing Address - Fax:
Practice Address - Street 1:304 S CLAIRBORNE RD STE 201
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-4107
Practice Address - Country:US
Practice Address - Phone:608-561-1754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical