Provider Demographics
NPI:1245099431
Name:CHEEKS, JENNIFER (CCHW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHEEKS
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1644
Mailing Address - Country:US
Mailing Address - Phone:614-273-9663
Mailing Address - Fax:
Practice Address - Street 1:1425 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1644
Practice Address - Country:US
Practice Address - Phone:614-273-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001333172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty