Provider Demographics
NPI:1023481405
Name:ANDERSON, NAOMI LEE (LMSW)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:LEE
Last Name:ANDERSON
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 1:9429 E SHANNON WAY CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4032
Mailing Address - Country:US
Mailing Address - Phone:316-634-1192
Mailing Address - Fax:
Practice Address - Street 1:9429 E SHANNON WAY CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-4032
Practice Address - Country:US
Practice Address - Phone:316-634-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical