Provider Demographics
NPI:1659094456
Name:JEAN ANDERSON, LLC
Entity Type:Organization
Organization Name:JEAN ANDERSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LSCSW
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-706-5818
Mailing Address - Street 1:3500 N ROCK RD BLDG 550
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1498
Mailing Address - Country:US
Mailing Address - Phone:316-706-5818
Mailing Address - Fax:
Practice Address - Street 1:3500 N ROCK RD BLDG 550
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1498
Practice Address - Country:US
Practice Address - Phone:316-706-5818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4641OtherLICENSE