Provider Demographics
NPI:1871857664
Name:COLE, KATHRYN ANN (LISW, MSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:COLE
Suffix:
Gender:F
Credentials:LISW, MSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:560 S TURQUOISE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1707
Mailing Address - Country:US
Mailing Address - Phone:937-765-6790
Mailing Address - Fax:
Practice Address - Street 1:560 S TURQUOISE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1707
Practice Address - Country:US
Practice Address - Phone:937-765-6790
Practice Address - Fax:937-999-4216
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18007791041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0337296Medicaid