Provider Demographics
NPI:1407620222
Name:SANCKEN, AMANDA (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SANCKEN
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 1:5841 SE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:KS
Mailing Address - Zip Code:66542-9743
Mailing Address - Country:US
Mailing Address - Phone:361-549-5599
Mailing Address - Fax:
Practice Address - Street 1:5841 SE 45TH ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:KS
Practice Address - Zip Code:66542-9743
Practice Address - Country:US
Practice Address - Phone:361-549-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker