Provider Demographics
NPI:1447766035
Name:LANE, JENNIFER C (QMHS,CMS,CDCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:LANE
Suffix:
Gender:F
Credentials:QMHS,CMS,CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1318
Mailing Address - Country:US
Mailing Address - Phone:513-651-9300
Mailing Address - Fax:513-352-1348
Practice Address - Street 1:911 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1318
Practice Address - Country:US
Practice Address - Phone:513-618-4229
Practice Address - Fax:513-352-1348
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.164623171M00000X
OHC.2405603-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator