Provider Demographics
NPI:1467032334
Name:COSPER, SIMONE (LSCSW)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:COSPER
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 1:730 N WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3148
Mailing Address - Country:US
Mailing Address - Phone:316-308-6998
Mailing Address - Fax:
Practice Address - Street 1:7200 W 13TH ST N STE 103
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2943
Practice Address - Country:US
Practice Address - Phone:316-308-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS062791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical