Healthcare Provider Details

I. General information

NPI: 1326951989
Provider Name (Legal Business Name): JESSICA POWERS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SUNNYSIDE AVE
LAWRENCE KS
66045-7599
US

IV. Provider business mailing address

1000 SUNNYSIDE AVE
LAWRENCE KS
66045-7599
US

V. Phone/Fax

Practice location:
  • Phone: 224-406-4774
  • Fax:
Mailing address:
  • Phone: 224-406-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP03457
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: