Provider Demographics
NPI:1538769179
Name:CHADWICK, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CHADWICK
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 1:5505 FOXRIDGE DR # 105
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1556
Mailing Address - Country:US
Mailing Address - Phone:913-274-1736
Mailing Address - Fax:
Practice Address - Street 1:5505 FOXRIDGE DR # 105
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-1556
Practice Address - Country:US
Practice Address - Phone:913-274-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03188106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist