Provider Demographics
NPI:1578105235
Name:NEWTON, JENNIE LYNNE (RA)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:LYNNE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N MAIN ST LOWR APT
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:OH
Mailing Address - Zip Code:45321-5007
Mailing Address - Country:US
Mailing Address - Phone:937-733-2494
Mailing Address - Fax:
Practice Address - Street 1:228 N BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1704
Practice Address - Country:US
Practice Address - Phone:937-456-7694
Practice Address - Fax:937-456-7753
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRA.162092405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional