Provider Demographics
NPI:1235782574
Name:BASTON, JENNIFER E (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:BASTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:BASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:668 SE BAYBERRY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4366
Mailing Address - Country:US
Mailing Address - Phone:816-679-1936
Mailing Address - Fax:
Practice Address - Street 1:668 SE BAYBERRY LN STE 101
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4366
Practice Address - Country:US
Practice Address - Phone:816-679-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional