Provider Demographics
NPI:1063512739
Name:ERIKSON, JEANNE (LSCSW)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:ERIKSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 555
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3007
Mailing Address - Country:US
Mailing Address - Phone:316-776-2317
Mailing Address - Fax:833-377-0520
Practice Address - Street 1:200 W DOUGLAS AVE STE 560
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3020
Practice Address - Country:US
Practice Address - Phone:316-269-2322
Practice Address - Fax:316-269-2448
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS044759Medicare PIN