Provider Demographics
NPI:1205110871
Name:WISCHMEIER, ANDRA (LMLP)
Entity type:Individual
Prefix:
First Name:ANDRA
Middle Name:
Last Name:WISCHMEIER
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAINE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1368
Mailing Address - Country:US
Mailing Address - Phone:785-843-9192
Mailing Address - Fax:785-843-2219
Practice Address - Street 1:200 MAINE ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1368
Practice Address - Country:US
Practice Address - Phone:785-843-9192
Practice Address - Fax:785-843-2219
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMLP 1426103T00000X
KS2400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist