Provider Demographics
NPI:1912088824
Name:SKRZYPEK, GLENDA LEE (PHD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:LEE
Last Name:SKRZYPEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72732-0237
Mailing Address - Country:US
Mailing Address - Phone:316-269-5000
Mailing Address - Fax:316-269-0404
Practice Address - Street 1:215 N LAMAR AVE
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1266
Practice Address - Country:US
Practice Address - Phone:316-269-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100329250AMedicaid
KS066966OtherBLUE CROSS BLUE SHIELD
KS100329250AMedicaid
KSS93152Medicare UPIN