Provider Demographics
NPI:1831296581
Name:KILLE, MARCELLA J (LSCSW)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:J
Last Name:KILLE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:J
Other - Last Name:RATZLAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10419 N TOBACCO RD
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-8684
Mailing Address - Country:US
Mailing Address - Phone:620-921-1029
Mailing Address - Fax:
Practice Address - Street 1:101 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-7147
Practice Address - Country:US
Practice Address - Phone:620-921-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS38621041C0700X
KS5977104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098120AMedicaid