Provider Demographics
NPI:1730485806
Name:WELLNESS WITH PAT
Entity Type:Organization
Organization Name:WELLNESS WITH PAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JACKSON-ISTAS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-313-0900
Mailing Address - Street 1:2048 STEPHEN CT
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7590
Mailing Address - Country:US
Mailing Address - Phone:785-313-0900
Mailing Address - Fax:785-537-8028
Practice Address - Street 1:2048 STEPHEN CT
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7590
Practice Address - Country:US
Practice Address - Phone:785-313-0900
Practice Address - Fax:785-537-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty