Provider Demographics
NPI:1508139866
Name:IRENE BOCKELMAN, LSCSW, LLC
Entity Type:Organization
Organization Name:IRENE BOCKELMAN, LSCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-634-4196
Mailing Address - Street 1:16102 W 124TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-4310
Mailing Address - Country:US
Mailing Address - Phone:913-634-4196
Mailing Address - Fax:913-780-6955
Practice Address - Street 1:10965 GRANADA LN
Practice Address - Street 2:SUITE 103
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1469
Practice Address - Country:US
Practice Address - Phone:913-634-4196
Practice Address - Fax:913-780-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 8631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0007634Medicare UPIN