Provider Demographics
NPI:1700821279
Name:WALLINGFORD, PRISCILLA NONE (MSN, MA, PHD, LP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:NONE
Last Name:WALLINGFORD
Suffix:
Gender:F
Credentials:MSN, MA, PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13140 EL MONTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:913-345-1905
Mailing Address - Fax:913-345-1933
Practice Address - Street 1:13140 EL MONTE ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-4159
Practice Address - Country:US
Practice Address - Phone:913-345-1905
Practice Address - Fax:913-345-1933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1121103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral