Provider Demographics
NPI:1790495901
Name:LIGHTFOOT, JENNIFER R (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 SW ROYALE CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4728
Mailing Address - Country:US
Mailing Address - Phone:307-277-6373
Mailing Address - Fax:
Practice Address - Street 1:6000 LAMAR AVE STE 130
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3234
Practice Address - Country:US
Practice Address - Phone:913-826-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12909104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker