Provider Demographics
NPI:1699528786
Name:MADDUX, HEATHER DAWN (LMSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:MADDUX
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 1:13918 E 79TH ST S
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-9633
Mailing Address - Country:US
Mailing Address - Phone:316-300-1464
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST STE 730
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4267
Practice Address - Country:US
Practice Address - Phone:316-202-2110
Practice Address - Fax:316-226-8648
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker