Provider Demographics
NPI:1023074663
Name:REICHART-VERNON, TERESA LYNN (LSCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:REICHART-VERNON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 N 130TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-9142
Mailing Address - Country:US
Mailing Address - Phone:913-207-7674
Mailing Address - Fax:913-721-1399
Practice Address - Street 1:134 N 130TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-9142
Practice Address - Country:US
Practice Address - Phone:913-207-7674
Practice Address - Fax:913-721-1399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000E423Medicare ID - Type UnspecifiedLICENSED CLINICAL SOCIAL