Provider Demographics
NPI:1821070319
Name:HASTINGS, KATHLEEN A (LSCSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:HASTINGS
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 1:815 N WACO
Mailing Address - Street 2:S-36
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203
Mailing Address - Country:US
Mailing Address - Phone:316-425-7080
Mailing Address - Fax:316-425-7090
Practice Address - Street 1:815 N WACO
Practice Address - Street 2:S-36
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203
Practice Address - Country:US
Practice Address - Phone:315-425-7080
Practice Address - Fax:316-425-7090
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS09231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
035210Medicare ID - Type Unspecified