1891876017 NPI number — MRS. JENNIFER GERSITZ WELLS MSW; LISW

Table of content: MRS. JENNIFER GERSITZ WELLS MSW; LISW (NPI 1891876017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891876017 NPI number — MRS. JENNIFER GERSITZ WELLS MSW; LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLS
Provider First Name:
JENNIFER
Provider Middle Name:
GERSITZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW; LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891876017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4075 OLD WESTERN ROW ROAD
Provider Second Line Business Mailing Address:
LINDNER CENTER OF HOPE
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-536-0626
Provider Business Mailing Address Fax Number:
513-536-0619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4075 OLD WESTERN ROW ROAD
Provider Second Line Business Practice Location Address:
LINDNER CENTER OF HOPE
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45040-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-536-0626
Provider Business Practice Location Address Fax Number:
513-536-0619
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  1-0005666 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 1.0005666 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)