Provider Demographics
NPI:1740827955
Name:CLARKE, JENNA MICHELLE (LISW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MICHELLE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MICHELLE
Other - Last Name:SLAMKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 GLENSPRINGS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2353
Mailing Address - Country:US
Mailing Address - Phone:513-904-5075
Mailing Address - Fax:
Practice Address - Street 1:415 GLENSPRINGS DR STE 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2353
Practice Address - Country:US
Practice Address - Phone:513-904-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2004723104100000X
OH171M00000X
OHI.22041681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0391468Medicaid