MEDICARE: JENNIFER KNISLEY MSW, LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1205595675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KNISLEY MSW, LSW

Provider Business Mailing Address
First Line	:	61 S STANFIELD RD
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2992
Country	:	US
Telephone Number	:	937-335-3701
Fax Number	:	937-335-7291

Provider Business Practice Location Address
First Line	:	61 S STANFIELD RD
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2992
Country	:	US
Telephone Number	:	937-335-3701
Fax Number	:	937-335-7291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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