Provider Demographics
NPI:1669029872
Name:SCOTT, JENNIS LYNN (LSW, CDCA)
Entity Type:Individual
Prefix:
First Name:JENNIS
Middle Name:LYNN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 EAST CRESCENTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1302
Mailing Address - Country:US
Mailing Address - Phone:513-671-7117
Mailing Address - Fax:513-671-7110
Practice Address - Street 1:44 E CRESCENTVILLE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1302
Practice Address - Country:US
Practice Address - Phone:513-671-7117
Practice Address - Fax:513-671-7110
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.22081021041C0700X
OH120683101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical