Provider Demographics
NPI:1881978864
Name:AYALA, IGNACIO VASQUEZ (LMSW)
Entity type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:VASQUEZ
Last Name:AYALA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 E DOUGLAS AVE # 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3325
Mailing Address - Country:US
Mailing Address - Phone:316-204-7759
Mailing Address - Fax:316-337-5249
Practice Address - Street 1:3428 E DOUGLAS AVE # 1
Practice Address - Street 2:STUITE 102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3325
Practice Address - Country:US
Practice Address - Phone:316-204-7759
Practice Address - Fax:316-337-5249
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7968104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2008775060AMedicaid