Provider Demographics
NPI:1508439126
Name:GUNN, JENNIFER KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KATHLEEN
Last Name:GUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 CAROLINE AVE APT S003
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-5334
Mailing Address - Country:US
Mailing Address - Phone:316-633-5166
Mailing Address - Fax:
Practice Address - Street 1:10209 W CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4685
Practice Address - Country:US
Practice Address - Phone:913-777-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC03865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health