Provider Demographics
NPI:1073837811
Name:ZOHN, JEANETTE T (LSW, PN-MEDS)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:T
Last Name:ZOHN
Suffix:
Gender:F
Credentials:LSW, PN-MEDS
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:Z
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:975 KINGSVIEW DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9562
Mailing Address - Country:US
Mailing Address - Phone:513-228-7854
Mailing Address - Fax:513-228-7848
Practice Address - Street 1:975 KINGSVIEW DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9562
Practice Address - Country:US
Practice Address - Phone:513-228-7800
Practice Address - Fax:513-228-7848
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-00298291041C0700X
OHPN-074728-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No164W00000XNursing Service ProvidersLicensed Practical Nurse