Provider Demographics
NPI:1578243812
Name:JANK, KYLIE ANN (LMLP-T)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANN
Last Name:JANK
Suffix:
Gender:F
Credentials:LMLP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7961
Mailing Address - Country:US
Mailing Address - Phone:785-829-3103
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST STE 730
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4267
Practice Address - Country:US
Practice Address - Phone:316-395-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03244-T103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist