Provider Demographics
NPI:1356899504
Name:HUPKO, ALLYSA LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ALLYSA
Middle Name:LYNN
Last Name:HUPKO
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 1:646 S QUENTIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2028
Mailing Address - Country:US
Mailing Address - Phone:316-807-4418
Mailing Address - Fax:
Practice Address - Street 1:646 S QUENTIN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2028
Practice Address - Country:US
Practice Address - Phone:316-807-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10187104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker