Provider Demographics
NPI:1346771516
Name:CHILDERS, KIMBERLY (LSCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:
Credentials:LSCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:7570 W 21ST ST N STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-469-1106
Mailing Address - Fax:833-392-1160
Practice Address - Street 1:7570 W 21ST ST N STE A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-469-1106
Practice Address - Fax:833-392-1160
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10047104100000X
KS054001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004585050003Medicaid