Provider Demographics
NPI:1679279335
Name:WHATLEY, JENNIFER (LISW-S)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE, ML 5021
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-4225
Mailing Address - Fax:
Practice Address - Street 1:5052 HAMILTON MASON RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-8492
Practice Address - Country:US
Practice Address - Phone:513-863-7060
Practice Address - Fax:513-887-5483
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0009361-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker