Provider Demographics
NPI:1245955228
Name:WEAVER, JESSICA NICOLE (SWT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 OLD HENDERSON RD # E262
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3626
Mailing Address - Country:US
Mailing Address - Phone:614-824-4285
Mailing Address - Fax:
Practice Address - Street 1:1550 OLD HENDERSON RD # E262
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3626
Practice Address - Country:US
Practice Address - Phone:614-824-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2202690-TRNE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical