Provider Demographics
NPI:1689696619
Name:BECK, SALLY A (LSCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:BECK
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:GERLACH-BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:437 N TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2413
Mailing Address - Country:US
Mailing Address - Phone:316-264-8344
Mailing Address - Fax:316-263-5259
Practice Address - Street 1:437 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2413
Practice Address - Country:US
Practice Address - Phone:316-264-8344
Practice Address - Fax:316-263-5259
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS35921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201485OtherHEALTH PARTNERS OF KS
KS200613830AMedicaid
KS518383OtherVALUE OPTIONS
KS13552OtherPREFERRED HEALTH SYSTEMS
KS70826OtherBCBS
070941OtherBCBS
KSQ56545Medicare UPIN
KS200613830AMedicaid