Provider Demographics
NPI:1689714420
Name:VANVALKENBURGH, EVALYN OLIVIA (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:EVALYN
Middle Name:OLIVIA
Last Name:VANVALKENBURGH
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17519 BOND
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9108
Mailing Address - Country:US
Mailing Address - Phone:913-526-9019
Mailing Address - Fax:913-681-6661
Practice Address - Street 1:17519 BOND
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-9108
Practice Address - Country:US
Practice Address - Phone:913-526-9019
Practice Address - Fax:913-681-6661
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW822104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker