Provider Demographics
NPI:1538186531
Name:BURBACH-MEISSEN, JAN M (LSCSW)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:BURBACH-MEISSEN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:M
Other - Last Name:MEISSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW
Mailing Address - Street 1:240 N ROCK RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-684-3010
Mailing Address - Fax:316-686-7366
Practice Address - Street 1:240 N ROCK RD
Practice Address - Street 2:SUITE 303
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-684-3010
Practice Address - Fax:316-686-7366
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R76398Medicare UPIN
KS041487Medicare ID - Type Unspecified