Provider Demographics
NPI:1639907702
Name:CLINE, LAURA RED ROSE (LMSW-T)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RED ROSE
Last Name:CLINE
Suffix:
Gender:F
Credentials:LMSW-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15831 E STATE ROAD 2
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:KS
Mailing Address - Zip Code:67118-9134
Mailing Address - Country:US
Mailing Address - Phone:970-714-0446
Mailing Address - Fax:
Practice Address - Street 1:555 N WOODLAWN ST STE 3105
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3673
Practice Address - Country:US
Practice Address - Phone:316-251-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13801-T104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker