MEDICARE: JENNIFER FOLEY 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	101Y00000X	Counselor	S.0022730	OH
2	103K00000X	Behavior Analyst	S.0022730	OH

General Provider Information

NPI Number	:	1215335757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FOLEY LSW

Provider Business Mailing Address
First Line	:	1435 CINCINNATI ST
Second Line	:	SUITE 100
City	:	DAYTON
State	:	OH
Zip	:	45417-4614
Country	:	US
Telephone Number	:	937-449-0800
Fax Number	:	937-449-0881

Provider Business Practice Location Address
First Line	:	1435 CINCINNATI ST
Second Line	:	SUITE 100
City	:	DAYTON
State	:	OH
Zip	:	45417-4614
Country	:	US
Telephone Number	:	937-449-0800
Fax Number	:	937-449-0881

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

Provider Enumeration Date	:	12/16/2014
Last Update Date	:	12/16/2014

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Directions to “ JENNIFER FOLEY LSW” Practice Location

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