Provider Demographics
NPI:1972905511
Name:BROTHERTON, STEPHANIE (LMSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BROTHERTON
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:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-0677
Mailing Address - Country:US
Mailing Address - Phone:913-557-9096
Mailing Address - Fax:913-294-9247
Practice Address - Street 1:1537 S 5TH ST E
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-4186
Practice Address - Country:US
Practice Address - Phone:913-548-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 9316104100000X
KS05750LSCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker