Basic Information
| Provider Information | |||||||||
| NPI: | 1245782929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 W 6TH ST | ||||||||
| Address2: | STE A | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660494304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853711414 | ||||||||
| FaxNumber: | 7853714519 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 W 6TH ST | ||||||||
| Address2: | STE C | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660494304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853711414 | ||||||||
| FaxNumber: | 7853714519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2016 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 10022 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.