Provider Demographics
NPI:1861201238
Name:QUANDT, PEYTON
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:QUANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3645
Mailing Address - Country:US
Mailing Address - Phone:316-260-6889
Mailing Address - Fax:
Practice Address - Street 1:8100 E 22ND ST N BLDG 2100-4
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2330
Practice Address - Country:US
Practice Address - Phone:316-358-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14005104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker