Provider Demographics
NPI:1043420953
Name:COMER, M JENISE (MSW)
Entity Type:Individual
Prefix:MS
First Name:M
Middle Name:JENISE
Last Name:COMER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7416 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-6261
Mailing Address - Country:US
Mailing Address - Phone:816-213-9490
Mailing Address - Fax:660-543-8215
Practice Address - Street 1:7416 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-6261
Practice Address - Country:US
Practice Address - Phone:816-213-9490
Practice Address - Fax:660-543-8215
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical