Healthcare Provider Details

I. General information

NPI: 1871241455
Provider Name (Legal Business Name): JENNIFER HURD LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N COLLEGE PARK ST STE 700
DERBY KS
67037-3666
US

IV. Provider business mailing address

3478 N HICKAM CT
DERBY KS
67037
US

V. Phone/Fax

Practice location:
  • Phone: 316-765-1041
  • Fax:
Mailing address:
  • Phone: 316-351-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07272
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: