Provider Demographics
NPI:1720799208
Name:GONZALEZ-SOTO, DAISY ALEJANDRA (LMSW LMAC)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:ALEJANDRA
Last Name:GONZALEZ-SOTO
Suffix:
Gender:F
Credentials:LMSW LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 W 21ST ST N STE 100E
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1795
Mailing Address - Country:US
Mailing Address - Phone:316-830-5607
Mailing Address - Fax:
Practice Address - Street 1:527 N GROVE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4520
Practice Address - Country:US
Practice Address - Phone:316-262-2415
Practice Address - Fax:316-264-4734
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11430104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker