Provider Demographics
NPI:1538568456
Name:RILEY, PATRICIA D (LSCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:RILEY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N AMIDON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2137
Mailing Address - Country:US
Mailing Address - Phone:316-631-5477
Mailing Address - Fax:316-932-1556
Practice Address - Street 1:1900 N AMIDON AVE STE 210
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203
Practice Address - Country:US
Practice Address - Phone:316-631-5477
Practice Address - Fax:316-932-1556
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS48451041C0700X
KS9177104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201101020BMedicaid