Provider Demographics
NPI:1366844037
Name:BICA, JENNA (SSP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:BICA
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SSP
Mailing Address - Street 1:1135 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3655
Mailing Address - Country:US
Mailing Address - Phone:419-996-3402
Mailing Address - Fax:
Practice Address - Street 1:1135 N WEST ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3655
Practice Address - Country:US
Practice Address - Phone:419-996-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3150500103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool