Provider Demographics
NPI:1184977787
Name:KETNER, JESSICA ORLOV (MS, IMFT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ORLOV
Last Name:KETNER
Suffix:
Gender:F
Credentials:MS, IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 NORTHWOODS BLVD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4720
Mailing Address - Country:US
Mailing Address - Phone:614-214-1631
Mailing Address - Fax:
Practice Address - Street 1:92 NORTHWOODS BLVD
Practice Address - Street 2:SUITE C-2
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4720
Practice Address - Country:US
Practice Address - Phone:614-214-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006459106H00000X
OHF . 1400010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist