Provider Demographics
NPI:1588382154
Name:YENNI, JESSICA KATHLEEN (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:KATHLEEN
Last Name:YENNI
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KATHLEEN
Other - Last Name:YENNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:200 N BROADWAY AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2301
Mailing Address - Country:US
Mailing Address - Phone:316-425-7774
Mailing Address - Fax:
Practice Address - Street 1:200 N BROADWAY AVE FL 5
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2301
Practice Address - Country:US
Practice Address - Phone:316-425-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04140-T101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health