Provider Demographics
NPI:1013989458
Name:ABBOTT, MARY ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 SW PLASS CT STE D
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1925
Mailing Address - Country:US
Mailing Address - Phone:785-233-7138
Mailing Address - Fax:785-233-7089
Practice Address - Street 1:2914 SW PLASS CT
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1925
Practice Address - Country:US
Practice Address - Phone:785-233-7138
Practice Address - Fax:785-233-7089
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS770103T00000X, 103TB0200X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100239940AMedicaid
KS010948Medicare ID - Type Unspecified