Provider Demographics
NPI:1528351004
Name:HAMILTON, JACQUELINE M (LMSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21350 W 153RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5413
Mailing Address - Country:US
Mailing Address - Phone:913-499-8100
Mailing Address - Fax:913-499-8111
Practice Address - Street 1:419 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1105
Practice Address - Country:US
Practice Address - Phone:913-499-8100
Practice Address - Fax:913-499-8111
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
KS10275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker