Healthcare Provider Details

I. General information

NPI: 1467183780
Provider Name (Legal Business Name): JACOB MANFRED BIGUS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 W 6TH ST STE C
LAWRENCE KS
66049-4300
US

IV. Provider business mailing address

332 FUNSTON AVE
LAWRENCE KS
66044-1440
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-7599
  • Fax:
Mailing address:
  • Phone: 913-638-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12647
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12647
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: