Individual
MS. TONI LYNN DETHERAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
490 HUTTON CIR, LAWRENCE, KS 66049-4845
(785) 691-5653
Mailing address
490 HUTTON CIR, LAWRENCE, KS 66049-4845
(785) 691-5653
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW 8615
KS
Other
Enumeration date
10/02/2012
Last updated
10/02/2012
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