Provider Demographics
NPI:1144553439
Name:FLAIGLE, THERESA A (LMSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:FLAIGLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:A
Other - Last Name:BADWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 N TYLER RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3725
Mailing Address - Country:US
Mailing Address - Phone:316-869-2220
Mailing Address - Fax:316-869-2221
Practice Address - Street 1:123 N TYLER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3725
Practice Address - Country:US
Practice Address - Phone:316-869-2220
Practice Address - Fax:316-869-2221
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7543104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker