Provider Demographics
NPI:1427398775
Name:MARTIN, JENNIFER (LMA, PCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMA, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10597 MONTGOMERY RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-257-2409
Mailing Address - Fax:
Practice Address - Street 1:10597 MONTGOMERY RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-257-2409
Practice Address - Fax:513-257-2409
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900095103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst