Basic Information
Provider Information
NPI: 1942623285
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSTRANDER
FirstName: SONJA
MiddleName: K
NamePrefix: MS.
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2050 W 11TH ST N
Address2:  
City: WICHITA
State: KS
PostalCode: 672033006
CountryCode: US
TelephoneNumber: 3162675710
FaxNumber: 3162677510
Practice Location
Address1: 2050 W 11TH ST N
Address2:  
City: WICHITA
State: KS
PostalCode: 672033006
CountryCode: US
TelephoneNumber: 3162675710
FaxNumber: 3162677510
Other Information
ProviderEnumerationDate: 01/22/2014
LastUpdateDate: 01/22/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X7222KSY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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