Provider Demographics
NPI:1821324005
Name:DAY, WILMA LOUISE (KIPBS CERTIFICATED)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:LOUISE
Last Name:DAY
Suffix:
Gender:F
Credentials:KIPBS CERTIFICATED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-9746
Mailing Address - Country:US
Mailing Address - Phone:620-355-1468
Mailing Address - Fax:620-355-1469
Practice Address - Street 1:1400 LINCOLN
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860
Practice Address - Country:US
Practice Address - Phone:620-355-1468
Practice Address - Fax:620-355-1469
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS06-03103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1215058516Medicaid