Provider Demographics
NPI:1285616763
Name:PATRY, JANISE L (LSCSW)
Entity type:Individual
Prefix:
First Name:JANISE
Middle Name:L
Last Name:PATRY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MISS
Other - First Name:JANISE
Other - Middle Name:L
Other - Last Name:FERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:7570 W 21ST ST N
Mailing Address - Street 2:STE 1026D
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-729-6555
Mailing Address - Fax:316-634-4794
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:STE 1026D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-729-6555
Practice Address - Fax:316-634-4794
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW09391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
066064Medicare ID - Type Unspecified