Provider Demographics
NPI:1790083319
Name:STONE, JENNIFER M (LISW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:STONE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 W 5TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1905
Mailing Address - Country:US
Mailing Address - Phone:614-488-6285
Mailing Address - Fax:614-875-4121
Practice Address - Street 1:1971 W 5TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1905
Practice Address - Country:US
Practice Address - Phone:614-488-6285
Practice Address - Fax:614-875-4121
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00075261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW25102Medicare PIN