Provider Demographics
NPI:1861819278
Name:ANDERSON, JEAN L (LSCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:LAMKIN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW
Mailing Address - Street 1:1901 E 1ST ST
Mailing Address - Street 2:PO BOX 467
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0467
Mailing Address - Country:US
Mailing Address - Phone:316-284-6400
Mailing Address - Fax:316-284-6491
Practice Address - Street 1:9333 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2927
Practice Address - Country:US
Practice Address - Phone:316-634-4700
Practice Address - Fax:316-634-4770
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical