Provider Demographics
NPI:1952726127
Name:STROM, JENNIFER RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RENEE
Last Name:STROM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 EDWARDS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1941
Mailing Address - Country:US
Mailing Address - Phone:513-984-2284
Mailing Address - Fax:513-984-2423
Practice Address - Street 1:3805 EDWARDS RD STE 150
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1941
Practice Address - Country:US
Practice Address - Phone:513-984-2284
Practice Address - Fax:513-984-2423
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6949103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy