Provider Demographics
NPI:1265576805
Name:STUKE, KENDRA MARIE (LSCSW)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:MARIE
Last Name:STUKE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 POYNTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6355
Mailing Address - Country:US
Mailing Address - Phone:785-320-7331
Mailing Address - Fax:
Practice Address - Street 1:720 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6355
Practice Address - Country:US
Practice Address - Phone:785-320-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 38601041C0700X
KS32661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA-1618Medicare UPIN