Basic Information
| Provider Information | |||||||||
| NPI: | 1295403558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALTNER | ||||||||
| FirstName: | MEAGAN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 OLD MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671144805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167271580 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 N WOODLAWN ST STE 3105 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166851821 | ||||||||
| FaxNumber: | 3166850768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2021 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 9044 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.