Provider Demographics
NPI:1811200645
Name:PATRY, JULIE MARIE MEYER (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE MEYER
Last Name:PATRY
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 75194
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67275-0194
Mailing Address - Country:US
Mailing Address - Phone:316-308-0423
Mailing Address - Fax:
Practice Address - Street 1:5500 W KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2345
Practice Address - Country:US
Practice Address - Phone:316-308-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7633104100000X
AK8891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker