Provider Demographics
NPI:1861578577
Name:RANNEBECK, JOY K (LCP)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:K
Last Name:RANNEBECK
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3207
Mailing Address - Country:US
Mailing Address - Phone:785-766-5385
Mailing Address - Fax:
Practice Address - Street 1:3109 W 27TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3207
Practice Address - Country:US
Practice Address - Phone:785-766-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS147 LCP103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1629159389OtherWYANDOT CENTER NPI
KS100098080COtherWYANDOT CENTER SED WAIVER
KS100098080AMedicaid
KS100098080COtherWYANDOT CENTER SED WAIVER
KS100098080COtherWYANDOT CENTER SED WAIVER