Provider Demographics
NPI:1598791758
Name:HATHORNE, JESSIE HUSCHER (LSCSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:HUSCHER
Last Name:HATHORNE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-1366
Mailing Address - Country:US
Mailing Address - Phone:785-825-0208
Mailing Address - Fax:785-826-9708
Practice Address - Street 1:425 W IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2563
Practice Address - Country:US
Practice Address - Phone:785-825-0208
Practice Address - Fax:785-826-9708
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0706631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS070663Medicare ID - Type Unspecified