Provider Demographics
NPI:1457688970
Name:JENNINGS, PAMELA S (LSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 BANNER ST.
Mailing Address - Street 2:
Mailing Address - City:OHIO CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45874
Mailing Address - Country:US
Mailing Address - Phone:419-965-2567
Mailing Address - Fax:419-238-1955
Practice Address - Street 1:504 BANNER ST.
Practice Address - Street 2:
Practice Address - City:OHIO CITY
Practice Address - State:OH
Practice Address - Zip Code:45874
Practice Address - Country:US
Practice Address - Phone:419-965-2567
Practice Address - Fax:419-238-1955
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00249501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical