Provider Demographics
NPI:1568079614
Name:MADDEN, JENNIFER (LCMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-1954
Mailing Address - Country:US
Mailing Address - Phone:913-426-3386
Mailing Address - Fax:
Practice Address - Street 1:1642 MAIN STREET #3
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2440
Practice Address - Country:US
Practice Address - Phone:913-702-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist