Provider Demographics
NPI:1265646426
Name:PUMPHREY, WANDA C (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:C
Last Name:PUMPHREY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:WANDA
Other - Last Name:PUMPHREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSCSW
Mailing Address - Street 1:11 ANDERSON CT
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-1409
Mailing Address - Country:US
Mailing Address - Phone:316-304-2059
Mailing Address - Fax:316-681-0877
Practice Address - Street 1:250 N ROCK RD
Practice Address - Street 2:SUITE 300D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2203
Practice Address - Country:US
Practice Address - Phone:316-304-2059
Practice Address - Fax:316-681-0877
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS38371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical