Provider Demographics
NPI:1245782929
Name:ANDERSON, JENNIFER D (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 W 6TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4304
Mailing Address - Country:US
Mailing Address - Phone:785-371-1414
Mailing Address - Fax:785-371-4519
Practice Address - Street 1:2601 W 6TH ST
Practice Address - Street 2:STE C
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4304
Practice Address - Country:US
Practice Address - Phone:785-371-1414
Practice Address - Fax:785-371-4519
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker