Provider Demographics
NPI:1871830752
Name:DIMICK, LAURY J (LSCSW)
Entity Type:Individual
Prefix:MISS
First Name:LAURY
Middle Name:J
Last Name:DIMICK
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MISS
Other - First Name:LAURY
Other - Middle Name:
Other - Last Name:KUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:730 HOLLY LANE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-452-4930
Mailing Address - Fax:785-452-4932
Practice Address - Street 1:730 HOLLY LANE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-452-4930
Practice Address - Fax:785-452-4932
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200974070BMedicaid