Provider Demographics
NPI:1891876017
Name:WELLS, JENNIFER GERSITZ (MSW; LISW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GERSITZ
Last Name:WELLS
Suffix:
Gender:F
Credentials:MSW; LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 OLD WESTERN ROW ROAD
Mailing Address - Street 2:LINDNER CENTER OF HOPE
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-3104
Mailing Address - Country:US
Mailing Address - Phone:513-536-0626
Mailing Address - Fax:513-536-0619
Practice Address - Street 1:4075 OLD WESTERN ROW ROAD
Practice Address - Street 2:LINDNER CENTER OF HOPE
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3104
Practice Address - Country:US
Practice Address - Phone:513-536-0626
Practice Address - Fax:513-536-0619
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-0005666104100000X
OH1.0005666104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWESW28532Medicare PIN