Provider Demographics
NPI:1750861548
Name:NIEDENS, CHARLENE MICHELLE (LSCSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MICHELLE
Last Name:NIEDENS
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 1:4350 SHAWNEE MISSION PKWY STE 1200
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2528
Mailing Address - Country:US
Mailing Address - Phone:913-945-7310
Mailing Address - Fax:913-945-7563
Practice Address - Street 1:4350 SHAWNEE MISSION PKWY STE 1200
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-2528
Practice Address - Country:US
Practice Address - Phone:913-945-7310
Practice Address - Fax:913-945-7563
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS19231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical