Provider Demographics
NPI:1144592577
Name:SLATTERY, JENNY R (LISW-S)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8244 WESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4616
Mailing Address - Country:US
Mailing Address - Phone:440-543-7122
Mailing Address - Fax:216-766-6081
Practice Address - Street 1:6200 SOM CENTER RD STE D20
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2967
Practice Address - Country:US
Practice Address - Phone:440-528-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007103.SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker