Provider Demographics
NPI:1871771220
Name:KRENTZ, STACY LYNN (LMSW, QCSW)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:KRENTZ
Suffix:
Gender:F
Credentials:LMSW, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66617-1706
Mailing Address - Country:US
Mailing Address - Phone:785-231-0795
Mailing Address - Fax:785-267-1525
Practice Address - Street 1:1613 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2627
Practice Address - Country:US
Practice Address - Phone:785-231-0795
Practice Address - Fax:785-267-1525
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7044104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker