Provider Demographics
NPI:1578642294
Name:DULLEA, KAREN MAUREEN (MSW LSCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MAUREEN
Last Name:DULLEA
Suffix:
Gender:F
Credentials:MSW LSCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MAUREEN
Other - Last Name:BLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LSCSW
Mailing Address - Street 1:2024 NORTH WOODLAWN
Mailing Address - Street 2:SUITE 411
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1879
Mailing Address - Country:US
Mailing Address - Phone:316-684-2741
Mailing Address - Fax:316-684-9261
Practice Address - Street 1:2024 NORTH WOODLAWN
Practice Address - Street 2:SUITE 411
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1879
Practice Address - Country:US
Practice Address - Phone:316-684-2741
Practice Address - Fax:316-684-9261
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW4051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS011018Medicare ID - Type Unspecified