Provider Demographics
NPI:1730122474
Name:CLYATT-DUNPHY, EMMA (LSCSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CLYATT-DUNPHY
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 1:210 SOUTHWIND PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3184
Mailing Address - Country:US
Mailing Address - Phone:785-313-1401
Mailing Address - Fax:
Practice Address - Street 1:210 SOUTHWIND PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3184
Practice Address - Country:US
Practice Address - Phone:785-313-1401
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS09991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS044751Medicare ID - Type UnspecifiedMEDICARE PROVIDER #