Provider Demographics
NPI:1639289200
Name:PORTER, KATRINA L (LSCSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:L
Other - Last Name:FOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 MASSACHUSETTS ST
Mailing Address - Street 2:SUITE #408
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2868
Mailing Address - Country:US
Mailing Address - Phone:785-220-5690
Mailing Address - Fax:785-864-0014
Practice Address - Street 1:900 MASSACHUSETTS ST
Practice Address - Street 2:SUITE #408
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2868
Practice Address - Country:US
Practice Address - Phone:785-220-5690
Practice Address - Fax:785-864-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS36221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200631120AMedicaid
KSP00655165OtherRR MEDICARE
KSP00655165OtherRR MEDICARE