Provider Demographics
NPI:1134179864
Name:PATRICK, LAURA K (LSCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:PATRICK
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:K
Other - Last Name:LITZENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 FLEMING ST STE 4
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6162
Mailing Address - Country:US
Mailing Address - Phone:620-287-8200
Mailing Address - Fax:888-436-1643
Practice Address - Street 1:302 FLEMING ST STE 4
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846
Practice Address - Country:US
Practice Address - Phone:620-287-8200
Practice Address - Fax:888-436-1643
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 6062104100000X
KS39361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker