Provider Demographics
NPI:1427646454
Name:COLLINS-VICKERS, AMY M
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:COLLINS-VICKERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 SW 29TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-6201
Mailing Address - Country:US
Mailing Address - Phone:785-633-0400
Mailing Address - Fax:
Practice Address - Street 1:3927 SW 40TH TER
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66610-2328
Practice Address - Country:US
Practice Address - Phone:785-969-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6461104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty