Provider Demographics
NPI:1699020826
Name:SMALL, JENNIFER MARIE (LSW, MSW)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:MARIE
Last Name:SMALL
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 BLUEACRES DR APT 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6160
Mailing Address - Country:US
Mailing Address - Phone:513-518-3344
Mailing Address - Fax:
Practice Address - Street 1:551 CINCINNATI BATAVIA PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1518
Practice Address - Country:US
Practice Address - Phone:513-752-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical