| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 09/15/2021 |
| Last Update Date | 12/21/2021 |
| Certification Date | 12/21/2021 |
| Medicare PECOS PAC ID | 2365834512 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144310558 PECOS PAC ID: 2365680535 Enrollment ID: I20130529000612 |
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