Provider Demographics
NPI:1568657435
Name:GRONAU, MELISSA ANN (LSCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GRONAU
Suffix:
Gender:F
Credentials:LSCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 S RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1621
Mailing Address - Country:US
Mailing Address - Phone:316-685-9311
Mailing Address - Fax:316-633-4283
Practice Address - Street 1:146 S RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1621
Practice Address - Country:US
Practice Address - Phone:316-685-9311
Practice Address - Fax:316-633-4283
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS006101YA0400X
KS39031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS02073149Medicaid