Provider Demographics
NPI:1588702245
Name:WHITING, JERRI LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:JERRI
Middle Name:LYNN
Last Name:WHITING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:JERRI
Other - Middle Name:LYNN
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:618 SE 4TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2908
Mailing Address - Country:US
Mailing Address - Phone:816-554-7750
Mailing Address - Fax:816-554-7750
Practice Address - Street 1:618 SE 4TH ST STE 106
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2908
Practice Address - Country:US
Practice Address - Phone:816-554-7750
Practice Address - Fax:816-554-7750
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01805103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS23418044OtherBCBS OF KANSAS CITY
MS23418044OtherBCBS OF KANSAS CITY