Provider Demographics
NPI:1174856819
Name:POWELL, JENNIFER SUE (LISW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUE
Last Name:POWELL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TUSCARAWAS ST W
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-2042
Mailing Address - Country:US
Mailing Address - Phone:330-413-2931
Mailing Address - Fax:330-348-1748
Practice Address - Street 1:401 TUSCARAWAS ST W
Practice Address - Street 2:SUITE 501
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-2042
Practice Address - Country:US
Practice Address - Phone:330-413-2931
Practice Address - Fax:330-348-1748
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10002861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical