Provider Demographics
NPI:1790050904
Name:HUNDERTMARK, DENISE MARIE (LSCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:HUNDERTMARK
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2606 N FLEMING ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3254
Mailing Address - Country:US
Mailing Address - Phone:620-647-4921
Mailing Address - Fax:620-628-2592
Practice Address - Street 1:2606 N FLEMING ST STE 2
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3254
Practice Address - Country:US
Practice Address - Phone:620-647-4921
Practice Address - Fax:620-628-2592
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS056141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200381960CMedicaid