Provider Demographics
NPI:1265254361
Name:WEATHERWAX, KERRIN (EDD, LMSW)
Entity type:Individual
Prefix:
First Name:KERRIN
Middle Name:
Last Name:WEATHERWAX
Suffix:
Gender:F
Credentials:EDD, LMSW
Other - Prefix:DR
Other - First Name:KERRIN
Other - Middle Name:
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, LMSW
Mailing Address - Street 1:2328 OSPREY CT
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4827
Mailing Address - Country:US
Mailing Address - Phone:785-304-8147
Mailing Address - Fax:
Practice Address - Street 1:208 E 7TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4199
Practice Address - Country:US
Practice Address - Phone:785-628-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13804104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker