Provider Demographics
NPI:1568230159
Name:SMALL, ANDREW LEDDY (MSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEDDY
Last Name:SMALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 N GLANCEY ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7411
Mailing Address - Country:US
Mailing Address - Phone:316-258-1661
Mailing Address - Fax:
Practice Address - Street 1:1430 N GLANCEY ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-7411
Practice Address - Country:US
Practice Address - Phone:316-258-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker