Provider Demographics
NPI:1730109471
Name:BIDWELL, DIANE SUE (LSCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:SUE
Last Name:BIDWELL
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:SUE
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:22ND MEDICAL GROUP
Mailing Address - Street 2:57950 LEAVENWORTH
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3506
Mailing Address - Country:US
Mailing Address - Phone:316-759-2069
Mailing Address - Fax:
Practice Address - Street 1:22ND MEDICAL GROUP
Practice Address - Street 2:57950 LEAVENWORTH
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3506
Practice Address - Country:US
Practice Address - Phone:316-759-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS35941041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical