Provider Demographics
NPI:1841582988
Name:DYKES, STEPHANI (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:
Last Name:DYKES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STEPHANI
Other - Middle Name:
Other - Last Name:CRUSINBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5500 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1607
Mailing Address - Country:US
Mailing Address - Phone:316-651-3625
Mailing Address - Fax:316-651-3625
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-651-3625
Practice Address - Fax:316-651-3625
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7771104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker