Provider Demographics
NPI:1104935709
Name:OLBERDING, DUANE LEO (LSCSW)
Entity type:Individual
Prefix:MR
First Name:DUANE
Middle Name:LEO
Last Name:OLBERDING
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SW FAIRLAWN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-6400
Mailing Address - Country:US
Mailing Address - Phone:785-249-8477
Mailing Address - Fax:785-246-0814
Practice Address - Street 1:1505 SW FAIRLAWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-6400
Practice Address - Country:US
Practice Address - Phone:785-249-8477
Practice Address - Fax:785-246-0814
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069626Medicare ID - Type Unspecified