Provider Demographics
NPI:1164081691
Name:WRIGHT, JENNY MARIE
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:MARIE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1758
Mailing Address - Country:US
Mailing Address - Phone:417-682-5757
Mailing Address - Fax:417-682-5757
Practice Address - Street 1:100 S PREWITT ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-1760
Practice Address - Country:US
Practice Address - Phone:417-682-5757
Practice Address - Fax:417-682-5757
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker