Provider Demographics
NPI:1093148215
Name:WESTGERDES, JENNIFER (LSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WESTGERDES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-849-8204
Mailing Address - Fax:614-210-7280
Practice Address - Street 1:25 NORTH ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2193
Practice Address - Country:US
Practice Address - Phone:614-849-8204
Practice Address - Fax:614-210-7280
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.12011961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical