Provider Demographics
NPI:1336689777
Name:SHINNOCK, JESSICA (MSW, LISWS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SHINNOCK
Suffix:
Gender:F
Credentials:MSW, LISWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9122
Mailing Address - Country:US
Mailing Address - Phone:180-085-9566
Mailing Address - Fax:
Practice Address - Street 1:2865 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2643
Practice Address - Country:US
Practice Address - Phone:614-395-9493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16003271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical