Provider Demographics
NPI:1881781359
Name:THIESSEN, WALTER J (LSCSW)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:THIESSEN
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 N COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3115
Mailing Address - Country:US
Mailing Address - Phone:316-264-9903
Mailing Address - Fax:
Practice Address - Street 1:415 N POPLAR AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4529
Practice Address - Country:US
Practice Address - Phone:316-686-6671
Practice Address - Fax:316-686-1094
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical