Provider Demographics
NPI:1780223347
Name:ROJAS, JESSIE (LMSW)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:ROJAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:889 N MAIZE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4559
Mailing Address - Country:US
Mailing Address - Phone:316-835-9967
Mailing Address - Fax:316-669-4477
Practice Address - Street 1:889 N MAIZE RD STE 210
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4559
Practice Address - Country:US
Practice Address - Phone:316-835-9967
Practice Address - Fax:316-669-4477
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11565104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201272430AMedicaid