Provider Demographics
NPI:1912630161
Name:L'MINGGIO, JENNIFER (PRSS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:L'MINGGIO
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 STATE ROUTE 339
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5106
Mailing Address - Country:US
Mailing Address - Phone:740-856-1084
Mailing Address - Fax:
Practice Address - Street 1:4945 STATE ROUTE 339
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-5106
Practice Address - Country:US
Practice Address - Phone:740-993-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X, 171M00000X
OHCDCA.184403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator