Basic Information
| Provider Information | |||||||||
| NPI: | 1144267485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NISPEL | ||||||||
| FirstName: | SHANNA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672033602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607600 | ||||||||
| FaxNumber: | 3163837925 | ||||||||
| Practice Location | |||||||||
| Address1: | 934 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672033838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607525 | ||||||||
| FaxNumber: | 3163834590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1859 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 4214 | 01 | KS | PREFERRED HEALTH SYSTEMS | OTHER | 066218 | 01 | KS | BLUE CROSS BLUE SHIELD | OTHER | 2129065 | 01 | KS | CIGNA | OTHER |