Provider Demographics
NPI:1144650847
Name:HOSMAN, JENNIFER L (LCMFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:HOSMAN
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BLANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMFT
Mailing Address - Street 1:294 SE 120 AVE
Mailing Address - Street 2:
Mailing Address - City:ELLINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67526-9200
Mailing Address - Country:US
Mailing Address - Phone:620-566-7396
Mailing Address - Fax:
Practice Address - Street 1:155 SE 1 AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-9696
Practice Address - Country:US
Practice Address - Phone:620-792-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS244106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist