Individual
MS. JACQUE LYNN TAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, LAC
Contact information
Practice address
555 N WOODLAWN ST STE 102, 3105, WICHITA, KS 67208-3671
(316) 652-2590
(316) 652-2595
Mailing address
555 N WOODLAWN ST STE 102, 3105, WICHITA, KS 67208-3671
(316) 652-2590
(316) 652-2595
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
378
KS
104100000X
Social Worker
Primary
7528
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200714670A
—
KS
Enumeration date
01/31/2011
Last updated
12/06/2013
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