Provider Demographics
NPI:1447565403
Name:KELTNER WEST, DOMINICA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DOMINICA
Middle Name:
Last Name:KELTNER WEST
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 1:2225 W MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-5419
Mailing Address - Country:US
Mailing Address - Phone:316-832-2358
Mailing Address - Fax:
Practice Address - Street 1:520 S HOLLAND ST
Practice Address - Street 2:SUITE 401
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2096
Practice Address - Country:US
Practice Address - Phone:316-729-9965
Practice Address - Fax:316-854-0950
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5109104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker