Healthcare Provider Details

I. General information

NPI: 1790495901
Provider Name (Legal Business Name): JENNIFER R LIGHTFOOT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 LAMAR AVE STE 130
MISSION KS
66202-3234
US

IV. Provider business mailing address

4083 SW ROYALE CT
LEES SUMMIT MO
64082-4728
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-4200
  • Fax:
Mailing address:
  • Phone: 307-277-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12909
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: