Basic Information
| Provider Information | |||||||||
| NPI: | 1770615650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUZMA | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11483 SW 160TH ST | ||||||||
| Address2: | |||||||||
| City: | ROSE HILL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671337801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164252419 | ||||||||
| FaxNumber: | 3165299351 | ||||||||
| Practice Location | |||||||||
| Address1: | 4505 E 47TH ST S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672101651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164252419 | ||||||||
| FaxNumber: | 3165299351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | LMSW 3422 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.