Provider Demographics
NPI:1407581747
Name:DEAN, SELECIA
Entity Type:Individual
Prefix:
First Name:SELECIA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W OTIS AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-8713
Mailing Address - Country:US
Mailing Address - Phone:785-825-0541
Mailing Address - Fax:
Practice Address - Street 1:5745 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4202
Practice Address - Country:US
Practice Address - Phone:316-530-7480
Practice Address - Fax:316-515-2122
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12617104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004834530002Medicaid