Provider Demographics
NPI:1619606530
Name:DUNHAM, LARA KAYNE (MSW)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:KAYNE
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9282 STATE HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:REEDS
Mailing Address - State:MO
Mailing Address - Zip Code:64859-2210
Mailing Address - Country:US
Mailing Address - Phone:417-793-4028
Mailing Address - Fax:
Practice Address - Street 1:411 E MADISON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-5924
Practice Address - Country:US
Practice Address - Phone:620-232-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker