Provider Demographics
NPI:1720372691
Name:BRANDT, JENNIFER C (LISW-S, PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LISW-S, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3108
Mailing Address - Country:US
Mailing Address - Phone:614-354-8886
Mailing Address - Fax:
Practice Address - Street 1:1755 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3108
Practice Address - Country:US
Practice Address - Phone:614-354-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 88071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical