Provider Demographics
NPI:1912704065
Name:PELTZER, KRISTEN A
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:PELTZER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1208
Mailing Address - Country:US
Mailing Address - Phone:316-282-5787
Mailing Address - Fax:
Practice Address - Street 1:8100 E 22ND ST N STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2350
Practice Address - Country:US
Practice Address - Phone:316-201-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS138601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical