Provider Demographics
NPI:1790906444
Name:REID, JENNIFER (LSCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REID
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 1:151 N ROCK ISLAND ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2771
Mailing Address - Country:US
Mailing Address - Phone:316-263-1460
Mailing Address - Fax:316-263-1492
Practice Address - Street 1:151 N ROCK ISLAND ST APT 1F
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2771
Practice Address - Country:US
Practice Address - Phone:316-263-1460
Practice Address - Fax:316-263-1492
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000068522OtherBLUE CROSS BLUE SHIELD
KS0000068522OtherBLUE CROSS BLUE SHIELD