Provider Demographics
NPI:1699970137
Name:CREEK, DIANE (LMSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CREEK
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 1:1615 SW 8TH AVE
Mailing Address - Street 2:SHAWNEE COUNTY
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1633
Mailing Address - Country:US
Mailing Address - Phone:785-368-2095
Mailing Address - Fax:785-368-2098
Practice Address - Street 1:1615 SW 8TH AVE
Practice Address - Street 2:SHAWNEE COUNTY
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1633
Practice Address - Country:US
Practice Address - Phone:785-368-2095
Practice Address - Fax:785-368-2098
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW40151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSLMSW4015OtherSTATE LICENSE