Provider Demographics
NPI:1396478624
Name:DIAL, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 3RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-7118
Mailing Address - Country:US
Mailing Address - Phone:740-451-0074
Mailing Address - Fax:
Practice Address - Street 1:817 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1525
Practice Address - Country:US
Practice Address - Phone:740-451-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0378240Medicaid