Basic Information
| Provider Information | |||||||||
| NPI: | 1912088824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKRZYPEK | ||||||||
| FirstName: | GLENDA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 237 | ||||||||
| Address2: | |||||||||
| City: | GARFIELD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727320237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162695000 | ||||||||
| FaxNumber: | 3162690404 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 N LAMAR AVE | ||||||||
| Address2: | |||||||||
| City: | HAYSVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670601266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162695000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 10/22/2016 | ||||||||
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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 | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 100329250A | 05 | KS | MEDICAID | 066966 | 01 | KS | BLUE CROSS BLUE SHIELD | OTHER |