Provider Demographics
NPI:1134789613
Name:GALLAWAY, DEBRA L (LSCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:GALLAWAY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31642 KEENE ESKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66507-8633
Mailing Address - Country:US
Mailing Address - Phone:785-640-3676
Mailing Address - Fax:
Practice Address - Street 1:31642 KEENE ESKRIDGE RD
Practice Address - Street 2:
Practice Address - City:MAPLE HILL
Practice Address - State:KS
Practice Address - Zip Code:66507-8633
Practice Address - Country:US
Practice Address - Phone:785-640-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical