Healthcare Provider Details

I. General information

NPI: 1366358939
Provider Name (Legal Business Name): JORDAN LEIGH THOMAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W 8TH ST
LAWRENCE KS
66044-2605
US

IV. Provider business mailing address

1424 W 22ND ST
LAWRENCE KS
66046-2718
US

V. Phone/Fax

Practice location:
  • Phone: 307-677-3791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP03479T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: