Provider Demographics
NPI:1952692139
Name:PRICE, JENNIFER LYNN (PCC, LCDCIII)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:PRICE
Suffix:
Gender:F
Credentials:PCC, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5647 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2460
Mailing Address - Country:US
Mailing Address - Phone:513-827-8122
Mailing Address - Fax:513-745-9651
Practice Address - Street 1:7439 MONTGOMERY RD STE 4
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4183
Practice Address - Country:US
Practice Address - Phone:513-827-8122
Practice Address - Fax:513-745-9651
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0701183101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor