Provider Demographics
NPI:1548466154
Name:MEMMOTT, JAY L (LCSW)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:MEMMOTT
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 W 110TH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2461
Mailing Address - Country:US
Mailing Address - Phone:913-327-7505
Mailing Address - Fax:
Practice Address - Street 1:8400 W 110TH ST STE 250
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2461
Practice Address - Country:US
Practice Address - Phone:913-327-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05451041C0700X
KSLSCSW 05451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical