Basic Information
| Provider Information | |||||||||
| NPI: | 1437719580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAYTAN | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | PATRICIA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 766 | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678460766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202751766 | ||||||||
| FaxNumber: | 6202754729 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 SAINT JOHN ST | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202751766 | ||||||||
| FaxNumber: | 6202754729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2019 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 11293 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.