Active NPI
Jennifer Ann Prohaska, PH.D.
- Clinical Psychologist
- Kansas City, KS
National Provider Identifier
1104180447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2124
- Practice address
- 3901 Rainbow Blvd
Mailstop 4015
Kansas City, KS 66103-2937 - Phone
- (913) 588-6400
- NPI assigned
- Jul 2, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2124 | KS | Primary |
Addresses
Primary practice location
3901 Rainbow Blvd
Mailstop 4015
Kansas City, KS 66103-2937
Mailing address
3901 Rainbow Blvd
Mailstop 4015
Kansas City, KS 66103-2937
Phone (913) 588-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2124 | KS | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366848000000",
"number": "1104180447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3901 RAINBOW BLVD",
"address_2": "MAILSTOP 4015",
"city": "KANSAS CITY",
"state": "KS",
"postal_code": "661032937",
"telephone_number": "913-588-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 RAINBOW BLVD",
"address_2": "MAILSTOP 4015",
"city": "KANSAS CITY",
"state": "KS",
"postal_code": "661032937",
"telephone_number": "913-588-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROHASKA",
"first_name": "JENNIFER",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-02",
"last_updated": "2013-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "2124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.