Provider Demographics
NPI:1356551345
Name:MCKENNEY, JASON ALEXANDER (LMSW)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALEXANDER
Last Name:MCKENNEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 CHATFIELD PL
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3208
Mailing Address - Country:US
Mailing Address - Phone:316-208-1031
Mailing Address - Fax:
Practice Address - Street 1:3323 CHATFIELD PL
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3208
Practice Address - Country:US
Practice Address - Phone:316-208-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6194104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker