Provider Demographics
NPI:1699451336
Name:THEOBALD, ZOE (LMSW)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:THEOBALD
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 1:3502 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2258
Mailing Address - Country:US
Mailing Address - Phone:785-312-4752
Mailing Address - Fax:785-371-0037
Practice Address - Street 1:3502 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2258
Practice Address - Country:US
Practice Address - Phone:785-312-4752
Practice Address - Fax:785-371-0037
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS131471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical