Provider Demographics
NPI:1477325082
Name:MASS, WILLIAM JEROME
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JEROME
Last Name:MASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 N ESTANCIA CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-8728
Mailing Address - Country:US
Mailing Address - Phone:620-388-3225
Mailing Address - Fax:
Practice Address - Street 1:4024 W 74TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-2943
Practice Address - Country:US
Practice Address - Phone:620-388-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician