Jennifer D Forman-wright, Lscsw, Llc | |
9200 Indian Creek Pkwy Ste 660 Overland Park KS 66210-2097 | |
(913) 523-3365 | |
(816) 305-0104 |
Full Name | Jennifer D Forman-wright, Lscsw, Llc |
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Speciality | Social Worker |
Location | 9200 Indian Creek Pkwy Ste 660, Overland Park, Kansas |
Authorized Official Name and Position | Jennifer Forman-wright (OWNER) |
Authorized Official Contact | 8162130010 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Jennifer D Forman-wright, Lscsw, Llc 9200 Indian Creek Pkwy Ste 660 Overland Park KS 66210-2097 Ph: (913) 523-3365 | Jennifer D Forman-wright, Lscsw, Llc 9200 Indian Creek Pkwy Ste 660 Overland Park KS 66210-2097 Ph: (913) 523-3365 |
NPI Number | 1144990771 |
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Provider Enumeration Date | 09/15/2021 |
Last Update Date | 12/21/2021 |
Certification Date | 12/21/2021 |
Medicare PECOS PAC ID | 2365834512 |
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Medicare Enrollment ID | O20220119002725 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144990771 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Jennifer D Forman-wright |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1144310558 PECOS PAC ID: 2365680535 Enrollment ID: I20130529000612 |
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