Provider Demographics
NPI:1508318908
Name:RICKLEFS, MICHELLE (LMSW, LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RICKLEFS
Suffix:
Gender:F
Credentials:LMSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3725
Mailing Address - Country:US
Mailing Address - Phone:316-239-8438
Mailing Address - Fax:
Practice Address - Street 1:4505 E 47TH ST S
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-1651
Practice Address - Country:US
Practice Address - Phone:316-524-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLAC-501101YA0400X
KSLMSW-9796104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)