Provider Demographics
NPI:1386300515
Name:AZAR, JENNIFER ELAINE (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:AZAR
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 W 31ST ST S APT 203
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-1168
Mailing Address - Country:US
Mailing Address - Phone:316-409-8225
Mailing Address - Fax:
Practice Address - Street 1:545 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3645
Practice Address - Country:US
Practice Address - Phone:316-409-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS058131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty