Provider Demographics
NPI:1558391805
Name:FENSKE-DOYLE, JENNIFER K (MSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:K
Last Name:FENSKE-DOYLE
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055E CENTERVILLE STATION RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5500
Mailing Address - Country:US
Mailing Address - Phone:937-439-2984
Mailing Address - Fax:937-439-2984
Practice Address - Street 1:1055E CENTERVILLE STATION RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-5500
Practice Address - Country:US
Practice Address - Phone:937-439-2984
Practice Address - Fax:937-439-2984
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-9170101YM0800X
OHI00091701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0251950Medicaid
OH0074861OtherODADAS
OH576154-000OtherMAGELLAN MIS #
OH0074946Medicaid
OH576154-000OtherMAGELLAN MIS #