Provider Demographics
NPI:1538119193
Name:EWING, AMY S (LMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:EWING
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 1:531 CAMPUS VIEW ST
Mailing Address - Street 2:PO BOX 477
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-7904
Mailing Address - Country:US
Mailing Address - Phone:620-275-0644
Mailing Address - Fax:620-272-0239
Practice Address - Street 1:531 CAMPUS VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-7904
Practice Address - Country:US
Practice Address - Phone:620-275-0644
Practice Address - Fax:620-272-0239
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 5927104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker