Provider Demographics
NPI:1750165072
Name:LAVENDER, HEIDI (LMSW)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:LAVENDER
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 1:518 S VOLUTSIA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2931
Mailing Address - Country:US
Mailing Address - Phone:316-285-5251
Mailing Address - Fax:
Practice Address - Street 1:659 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3515
Practice Address - Country:US
Practice Address - Phone:316-285-0748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13267104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker