Provider Demographics
NPI:1568616043
Name:WALSH, JANNA J (T/LMLP)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:J
Last Name:WALSH
Suffix:
Gender:F
Credentials:T/LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4529
Mailing Address - Country:US
Mailing Address - Phone:316-686-6671
Mailing Address - Fax:316-686-1094
Practice Address - Street 1:415 N POPLAR AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4529
Practice Address - Country:US
Practice Address - Phone:316-686-6671
Practice Address - Fax:316-686-1094
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1215103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist