Provider Demographics
NPI:1578037578
Name:WATTS, JENNIFER GAYE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GAYE
Last Name:WATTS
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 1:15809 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-8143
Mailing Address - Country:US
Mailing Address - Phone:816-365-4273
Mailing Address - Fax:816-468-6623
Practice Address - Street 1:3100 NE 83RD ST STE 1001
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-4460
Practice Address - Country:US
Practice Address - Phone:816-468-0400
Practice Address - Fax:816-468-6623
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8151104100000X
MO20140057951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker