Provider Demographics
NPI:1821016353
Name:O'NEILL, SHARON L (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:O'NEILL
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 1:1148 S. HILLSIDE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211
Mailing Address - Country:US
Mailing Address - Phone:316-687-0006
Mailing Address - Fax:316-687-0328
Practice Address - Street 1:1148 S. HILLSIDE
Practice Address - Street 2:SUITE 104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211
Practice Address - Country:US
Practice Address - Phone:316-687-0006
Practice Address - Fax:316-687-0328
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 08591041C0700X
KS08591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS011249OtherBLUE CROSS BLUE SHIELD
KS100388030AMedicaid
KS800010481OtherRR MEDICARE
R76073Medicare UPIN
KS800010481OtherRR MEDICARE