Provider Demographics
NPI:1912442831
Name:SAGE, WELLINGTON ROY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WELLINGTON
Middle Name:ROY
Last Name:SAGE
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 1:430 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-3836
Mailing Address - Country:US
Mailing Address - Phone:913-636-5459
Mailing Address - Fax:
Practice Address - Street 1:430 MAPLE ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3836
Practice Address - Country:US
Practice Address - Phone:913-636-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10251104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker