Provider Demographics
NPI:1407988199
Name:FRYE, JANA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:RAE
Last Name:FRYE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 NW WOOD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3140
Mailing Address - Country:US
Mailing Address - Phone:816-510-0220
Mailing Address - Fax:
Practice Address - Street 1:5028 NW WOOD RIDGE DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-3140
Practice Address - Country:US
Practice Address - Phone:816-510-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040058351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical