Basic Information
Provider Information
NPI: 1982080826
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCKINNEY
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 934 N WATER ST
Address2:  
City: WICHITA
State: KS
PostalCode: 672033838
CountryCode: US
TelephoneNumber: 3166607600
FaxNumber: 3169415075
Practice Location
Address1: 635 N MAIN ST
Address2:  
City: WICHITA
State: KS
PostalCode: 672033602
CountryCode: US
TelephoneNumber: 3166607500
FaxNumber: 3166601897
Other Information
ProviderEnumerationDate: 08/03/2015
LastUpdateDate: 08/03/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X9562KSY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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