Provider Demographics
NPI:1811501075
Name:FOKKEN, KAYELEE (LMSW)
Entity type:Individual
Prefix:
First Name:KAYELEE
Middle Name:
Last Name:FOKKEN
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 1:2726 COLONIAL ST APT C
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1885
Mailing Address - Country:US
Mailing Address - Phone:970-370-1368
Mailing Address - Fax:
Practice Address - Street 1:131 N SANTA FE AVE STE 300A
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2642
Practice Address - Country:US
Practice Address - Phone:620-794-7636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11757104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker