Provider Demographics
NPI:1932861044
Name:GRAHAM, ALLISON JEANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JEANNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4537
Mailing Address - Country:US
Mailing Address - Phone:316-371-6136
Mailing Address - Fax:
Practice Address - Street 1:355 N WACO ST STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-1122
Practice Address - Country:US
Practice Address - Phone:316-263-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11539104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker