Provider Demographics
NPI:1811988306
Name:BOCKELMAN, IRENE (LSCSW LCMFT)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:BOCKELMAN
Suffix:
Gender:F
Credentials:LSCSW LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16102 W 124TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-4310
Mailing Address - Country:US
Mailing Address - Phone:913-634-4196
Mailing Address - Fax:913-780-6955
Practice Address - Street 1:16102 W 124TH TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-4310
Practice Address - Country:US
Practice Address - Phone:913-634-4196
Practice Address - Fax:913-780-6955
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW8631041C0700X
KS239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0007634Medicare ID - Type Unspecified