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NPI Code Detail

MEDICARE: JENNIFER K MACKEY LMSW, LAC

MEDICARE: JENNIFER K MACKEY LMSW, LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker10534KS
2101YA0400XAddiction (Substance Use Disorder) Counselor665KS

General Provider Information

NPI Number : 1851736607
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER K MACKEY LMSW, LAC
Provider Business Mailing Address
First Line : 714 S HILLSIDE
Second Line :
City : WICHITA
State : KS
Zip : 67211-3602
Country : US
Telephone Number : 316-295-4800
Fax Number : 316-295-4811
Provider Business Practice Location Address
First Line : 714 S HILLSIDE ST
Second Line :
City : WICHITA
State : KS
Zip : 67211-3002
Country : US
Telephone Number : 316-295-4800
Fax Number : 316-295-4811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2013
Last Update Date : 07/21/2022

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