Provider Demographics
NPI:1245803311
Name:NORMAN, JENNIFER LEE (CDCAII183364)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:NORMAN
Suffix:
Gender:
Credentials:CDCAII183364
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1569 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8429
Mailing Address - Country:US
Mailing Address - Phone:513-575-0968
Mailing Address - Fax:513-575-1019
Practice Address - Street 1:1569 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8429
Practice Address - Country:US
Practice Address - Phone:513-575-0968
Practice Address - Fax:513-932-6750
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
CDCA.183364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist