Individual
JACKLYN R DERSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
2604 W 9TH ST N, WICHITA, KS 67203-4731
(316) 295-4758
Mailing address
2561 S GREENWOOD ST, WICHITA, KS 67216-1255
(316) 734-8855
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1250
KS
Other
Enumeration date
11/16/2011
Last updated
11/16/2011
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