Provider Demographics
NPI:1932547007
Name:LATIMER, VICKI M (LMSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:M
Last Name:LATIMER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2707 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2249
Mailing Address - Country:US
Mailing Address - Phone:316-691-0249
Mailing Address - Fax:316-691-9939
Practice Address - Street 1:2707 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2249
Practice Address - Country:US
Practice Address - Phone:316-691-0249
Practice Address - Fax:316-691-9939
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10065104100000X
KS067101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)