Provider Demographics
NPI:1497776272
Name:HAWTHORNE, JANET L (PH D)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ROCK RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2243
Mailing Address - Country:US
Mailing Address - Phone:316-719-3875
Mailing Address - Fax:316-719-3877
Practice Address - Street 1:250 N ROCK RD
Practice Address - Street 2:SUITE 365
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2243
Practice Address - Country:US
Practice Address - Phone:316-719-3875
Practice Address - Fax:316-719-3877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP0863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100355140AMedicaid
KS100355140AMedicaid
S22320Medicare UPIN