MEDICARE: PAMELA S JENNINGS 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	1041C0700X	Clinical Social Worker	S0024950	OH

General Provider Information

NPI Number	:	1457688970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA S JENNINGS LSW

Provider Business Mailing Address
First Line	:	504 BANNER ST.
Second Line	:
City	:	OHIO CITY
State	:	OH
Zip	:	45874
Country	:	US
Telephone Number	:	419-965-2567
Fax Number	:	419-238-1955

Provider Business Practice Location Address
First Line	:	504 BANNER ST.
Second Line	:
City	:	OHIO CITY
State	:	OH
Zip	:	45874
Country	:	US
Telephone Number	:	419-965-2567
Fax Number	:	419-238-1955

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

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	11/04/2009

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Directions to “ PAMELA S JENNINGS LSW” Practice Location

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