Provider Demographics
NPI:1578791075
Name:LYMAN ROBERSON, KIRSTEN L (LMSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:L
Last Name:LYMAN ROBERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIRSTEN L LYMAN
Other - Middle Name:
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:4505 E 47TH ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-1651
Mailing Address - Country:US
Mailing Address - Phone:316-529-9100
Mailing Address - Fax:316-529-9351
Practice Address - Street 1:560 N EXPOSITION ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5902
Practice Address - Country:US
Practice Address - Phone:316-264-8317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 4475104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker