Provider Demographics
NPI:1942729009
Name:MOYER, JENNIFER LYNN (DEM, DOULA, LMT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MOYER
Suffix:
Gender:F
Credentials:DEM, DOULA, LMT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:REEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:21552 ROAD I21
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45827-9593
Mailing Address - Country:US
Mailing Address - Phone:567-376-5262
Mailing Address - Fax:
Practice Address - Street 1:2328 TOWNLEY RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-4338
Practice Address - Country:US
Practice Address - Phone:419-356-4722
Practice Address - Fax:419-356-4722
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-012618225700000X
374J00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty