Provider Demographics
NPI:1720741796
Name:FERNANDEZ, PAIGE LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:LYNN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:LYNN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2501 E CENTRAL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3344
Mailing Address - Country:US
Mailing Address - Phone:505-414-1643
Mailing Address - Fax:
Practice Address - Street 1:2501 E CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3344
Practice Address - Country:US
Practice Address - Phone:505-414-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9803104100000X
KS12067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker