Provider Demographics
NPI:1851582548
Name:SWEENEY, JENNIFER J (PHD, COBA)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:PHD, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8536 CROW DR. SUITE 240
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056
Mailing Address - Country:US
Mailing Address - Phone:330-606-3633
Mailing Address - Fax:
Practice Address - Street 1:8536 CROW DR STE 240
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1986
Practice Address - Country:US
Practice Address - Phone:330-606-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH55103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicare UPIN