Provider Demographics
NPI:1124125141
Name:ESTILL, LANETTE H (LSCSW)
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:H
Last Name:ESTILL
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 1:12217 S MCNEW RD
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-8403
Mailing Address - Country:US
Mailing Address - Phone:620-727-4115
Mailing Address - Fax:
Practice Address - Street 1:1625 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1226
Practice Address - Country:US
Practice Address - Phone:888-878-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS835080OtherBCBS
KS100098120AMedicaid