Provider Demographics
NPI:1588037345
Name:JACQUELINE VONFELDT
Entity Type:Organization
Organization Name:JACQUELINE VONFELDT
Other - Org Name:WEST WICHITA COUPLE AND FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VONFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-202-8292
Mailing Address - Street 1:515 N RIDGE RD
Mailing Address - Street 2:200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6389
Mailing Address - Country:US
Mailing Address - Phone:316-202-8292
Mailing Address - Fax:
Practice Address - Street 1:515 N RIDGE RD
Practice Address - Street 2:200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6389
Practice Address - Country:US
Practice Address - Phone:316-202-8292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2717305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization