Provider Demographics
NPI:1689228132
Name:MANDICH, JESSICA D (BSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:MANDICH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 GLENSPRINGS DRIVE SUITE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246
Mailing Address - Country:US
Mailing Address - Phone:513-771-9600
Mailing Address - Fax:513-771-2546
Practice Address - Street 1:415 GLENSPRINGS DRIVE SUITE 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246
Practice Address - Country:US
Practice Address - Phone:513-771-9600
Practice Address - Fax:513-771-2546
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 171M00000X
OHS.1904285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator