Provider Demographics
NPI:1245769421
Name:DANNER, JAZMINE (LISW-S)
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:
Last Name:DANNER
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 1:99 W SAINT CLAIR AVE APT 1606
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1536
Mailing Address - Country:US
Mailing Address - Phone:216-202-0685
Mailing Address - Fax:
Practice Address - Street 1:99 W SAINT CLAIR AVE APT 1606
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-1536
Practice Address - Country:US
Practice Address - Phone:216-202-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21029251041C0700X
OHS1700686104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268082Medicaid