Provider Demographics
NPI:1386992691
Name:KASPER-DOGGETT, ANDREA LYNN (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:KASPER-DOGGETT
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 1:100 S MARKET ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3824
Mailing Address - Country:US
Mailing Address - Phone:316-361-0662
Mailing Address - Fax:844-766-7540
Practice Address - Street 1:100 S MARKET ST STE 2A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202
Practice Address - Country:US
Practice Address - Phone:316-361-0662
Practice Address - Fax:844-766-7540
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200965900AMedicaid
KS200965900DMedicaid