Provider Demographics
NPI:1093020067
Name:DAVIS, JENNIFER R (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 E HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1034
Mailing Address - Country:US
Mailing Address - Phone:614-365-8311
Mailing Address - Fax:614-365-8615
Practice Address - Street 1:737 E HUDSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1034
Practice Address - Country:US
Practice Address - Phone:614-365-8311
Practice Address - Fax:614-365-8615
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.12014791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid