=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972033017
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACOB SCOTT ASBRIDGE LSCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2017
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7200 W 13TH ST N
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67212-2970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-744-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 W ACADEMY AVE
-----------------------------------------------------
City | MAIZE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67101-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-462-8239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------