Provider Demographics
NPI:1184908568
Name:SCOTT, KRISTINA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-9061
Mailing Address - Country:US
Mailing Address - Phone:620-344-0855
Mailing Address - Fax:316-322-8513
Practice Address - Street 1:3913 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-9061
Practice Address - Country:US
Practice Address - Phone:620-344-0855
Practice Address - Fax:316-322-8513
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7573104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker