Provider Demographics
NPI:1467137646
Name:WOLVERTON, SAMANTHA JOANN (LMSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOANN
Last Name:WOLVERTON
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 1:3354 HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-7841
Mailing Address - Country:US
Mailing Address - Phone:620-331-1741
Mailing Address - Fax:620-332-1940
Practice Address - Street 1:3354 HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-7841
Practice Address - Country:US
Practice Address - Phone:620-331-1741
Practice Address - Fax:620-332-1940
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13149104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker