Healthcare Provider Details

I. General information

NPI: 1639095052
Provider Name (Legal Business Name): JENNIFER PALOMINO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15940 COLLEGE BLVD
LENEXA KS
66219-1305
US

IV. Provider business mailing address

480 S ROGERS RD
OLATHE KS
66062-1706
US

V. Phone/Fax

Practice location:
  • Phone: 913-324-3823
  • Fax:
Mailing address:
  • Phone: 913-324-3856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05391
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: