Provider Demographics
NPI:1184603516
Name:DETWEILER, DENNIS LEE (LSCSW)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEE
Last Name:DETWEILER
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-4075
Mailing Address - Country:US
Mailing Address - Phone:785-841-0262
Mailing Address - Fax:785-840-0709
Practice Address - Street 1:901 KENTUCKY ST
Practice Address - Street 2:SUITE 306
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2823
Practice Address - Country:US
Practice Address - Phone:785-841-0262
Practice Address - Fax:785-840-0709
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW - 16021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS11932Medicare UPIN
KS070864Medicare PIN
KS000C655Medicare ID - Type Unspecified