Individual
JENNIFER FORAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3751 W MAIN ST, INDEPENDENCE, KS 67301-8446
(620) 331-1748
Mailing address
PO BOX 688, INDEPENDENCE, KS 67301-0688
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LAC 1048
KS
103T00000X
Psychologist
Primary
852
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200439250A
—
KS
Enumeration date
08/24/2006
Last updated
12/01/2014
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