Individual
JESSICA ANNE BOULWARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
1421 N SPORT OF KINGS CT, WICHITA, KS 67230-7152
(316) 251-0896
Mailing address
1421 N SPORT OF KINGS CT, WICHITA, KS 67230-7152
(316) 251-0896
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
03553
KS
Other
Enumeration date
11/10/2023
Last updated
11/10/2023
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