Basic Information
| Provider Information | |||||||||
| NPI: | 1134425416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTENBECK | ||||||||
| FirstName: | TAUNYA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1602 BURNS ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672032756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162538303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3425 W CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672034919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169460990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2011 | ||||||||
| LastUpdateDate: | 02/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 7922 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.