Provider Demographics
NPI:1215732672
Name:WOODRUFF, KRISTIN JANAE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JANAE
Last Name:WOODRUFF
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 E 22ND ST N STE 2100-4
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2330
Mailing Address - Country:US
Mailing Address - Phone:316-358-7128
Mailing Address - Fax:
Practice Address - Street 1:8100 E 22ND ST N STE 2100-4
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2330
Practice Address - Country:US
Practice Address - Phone:316-358-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health