Healthcare Provider Details

I. General information

NPI: 1376795948
Provider Name (Legal Business Name): JENNIFER LUNDRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER COLEMAN BSW, MHPP

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1100
WEST PLAINS MO
65775-1100
US

IV. Provider business mailing address

PO BOX 1100
WEST PLAINS MO
65775-1100
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-6762
  • Fax: 417-257-5875
Mailing address:
  • Phone: 417-257-6762
  • Fax: 417-257-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2025006658
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: