Provider Demographics
NPI:1548078314
Name:AMBER LYNN WOGOMON LSCWS DOSE WELLNESS LLC
Entity type:Organization
Organization Name:AMBER LYNN WOGOMON LSCWS DOSE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOGOMON
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, LCAC
Authorized Official - Phone:785-614-5454
Mailing Address - Street 1:106 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:KS
Mailing Address - Zip Code:66937-9770
Mailing Address - Country:US
Mailing Address - Phone:785-614-5454
Mailing Address - Fax:
Practice Address - Street 1:106 BERRY ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:KS
Practice Address - Zip Code:66937-9770
Practice Address - Country:US
Practice Address - Phone:785-614-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty