Provider Demographics
NPI:1689435422
Name:DOERKSEN, ABIGAIL MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:MARIE
Last Name:DOERKSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:ABBY
Other - Middle Name:M
Other - Last Name:DOERKSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14905 W 150TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-4617
Mailing Address - Country:US
Mailing Address - Phone:131-625-8503
Mailing Address - Fax:
Practice Address - Street 1:8340 MISSION RD STE 230
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1319
Practice Address - Country:US
Practice Address - Phone:913-735-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMFT03351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty