Provider Demographics
NPI:1831317858
Name:BRILES-KLEIN, JOANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:BRILES-KLEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10209 W CENTRAL AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4684
Mailing Address - Country:US
Mailing Address - Phone:316-721-2349
Mailing Address - Fax:316-512-4070
Practice Address - Street 1:10209 W CENTRAL AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4684
Practice Address - Country:US
Practice Address - Phone:316-721-2349
Practice Address - Fax:316-512-4070
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW #8531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC2934AE2FBMedicare UPIN
KS267079Medicare UPIN
KS1872Medicare UPIN
KS69288Medicare UPIN