Individual
DIANE MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 W 4TH ST, COFFEYVILLE, KS 67337-3333
(620) 251-8180
Mailing address
1601 W 4TH ST, COFFEYVILLE, KS 67337-3333
(620) 251-8180
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
14255-T
KS
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/12/2024
Last updated
10/29/2025
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