Provider Demographics
NPI:1689027377
Name:HAVERKAMP, BRYNNE E (LSCSW, LMAC)
Entity Type:Individual
Prefix:
First Name:BRYNNE
Middle Name:E
Last Name:HAVERKAMP
Suffix:
Gender:F
Credentials:LSCSW, LMAC
Other - Prefix:
Other - First Name:BRYNNE
Other - Middle Name:E
Other - Last Name:HAVERKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-0747
Mailing Address - Country:US
Mailing Address - Phone:785-587-4300
Mailing Address - Fax:785-587-4377
Practice Address - Street 1:2001 CLAFLIN RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3415
Practice Address - Country:US
Practice Address - Phone:785-587-4300
Practice Address - Fax:785-587-4305
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS380101YA0400X
KS10015104100000X
KS51921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker