Provider Demographics
NPI:1942827589
Name:JENKINS, BAILEY (LSW)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 PARROTT STATION RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-8742
Mailing Address - Country:US
Mailing Address - Phone:740-406-8059
Mailing Address - Fax:
Practice Address - Street 1:5945 SAWMILL RD UNIT B
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1623
Practice Address - Country:US
Practice Address - Phone:614-389-3030
Practice Address - Fax:614-413-3536
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.173953101YA0400X
OHS.2105776104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty