Provider Demographics
NPI:1417021999
Name:SMITH, JENNIFER ANN (MED, PCC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5592 CRAWFORD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-4176
Mailing Address - Country:US
Mailing Address - Phone:614-846-6597
Mailing Address - Fax:
Practice Address - Street 1:453 ALLENBY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8722
Practice Address - Country:US
Practice Address - Phone:937-642-0048
Practice Address - Fax:937-642-1316
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0501056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional