Provider Demographics
NPI:1063733921
Name:CRENSHAW, LINDA R (LSCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:CRENSHAW
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 1:1314 N OLIVER AVE UNIT 20733
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0410
Mailing Address - Country:US
Mailing Address - Phone:316-519-0673
Mailing Address - Fax:913-224-1656
Practice Address - Street 1:7570 W 21ST ST NORTH
Practice Address - Street 2:BLDG 1046, STE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-776-4766
Practice Address - Fax:913-224-1656
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45891041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1710646393Medicaid