Provider Demographics
NPI:1982034971
Name:RECTOR, JOLEEN M
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:M
Last Name:RECTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66617-9223
Mailing Address - Country:US
Mailing Address - Phone:785-246-1208
Mailing Address - Fax:785-246-1208
Practice Address - Street 1:3420 NW 49TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2518
Practice Address - Country:US
Practice Address - Phone:785-246-1208
Practice Address - Fax:785-246-1208
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200577100AMedicaid