Provider Demographics
NPI:1568676674
Name:FITZGERALD, LINDA S (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 E BROOKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-4414
Mailing Address - Country:US
Mailing Address - Phone:316-207-3829
Mailing Address - Fax:
Practice Address - Street 1:250 N ROCK RD
Practice Address - Street 2:SUITE 300D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2203
Practice Address - Country:US
Practice Address - Phone:316-207-3829
Practice Address - Fax:316-681-0877
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 24061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS70308OtherBCBS
KS70308Medicare ID - Type Unspecified