Provider Demographics
NPI:1285696922
Name:VEENSTRA, GLENN J (PHD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:J
Last Name:VEENSTRA
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1010 N KANSAS
Mailing Address - Street 2:SUITE #3049
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3199
Mailing Address - Country:US
Mailing Address - Phone:316-293-2647
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:7829 E ROCKHILL ST
Practice Address - Street 2:SUITE #105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3920
Practice Address - Country:US
Practice Address - Phone:316-293-3850
Practice Address - Fax:316-683-6733
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-11-25
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Provider Licenses
StateLicense IDTaxonomies
KS0507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04414OtherBCBS
KS100237810AMedicaid
KS04414OtherBCBS
KS04414Medicare PIN