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Provider Information for 1508960055


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Mrs. SARALYN A. ATIVIE MSW, LMSW


Sex: Female

NPI: 1508960055
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1508960055
Enumeration Date2006-09-12
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 2912 S.14TH STREET
LEAVENWORTH, KS 66048
United States

Phone: 913-684-6769 | Fax:913-684-6766
 
Primary Practice Address 550 POPE AVE
FORT LEAVENWORTH, KS 66027-2332
United States

Phone: 913-684-6769 | Fax:913-684-6766
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalMI6801071684