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NPI Code Detail

MEDICARE: JESSICA LEA HENIZE

MEDICARE: JESSICA LEA HENIZE
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.168660OH

General Provider Information

NPI Number : 1649831207
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LEA HENIZE
Provider Business Mailing Address
First Line : 8153 TOLLBRIDGE CT
Second Line :
City : WEST CHESTER
State : OH
Zip : 45069-1692
Country : US
Telephone Number : 513-413-4458
Fax Number :
Provider Business Practice Location Address
First Line : 1215 1ST AVE
Second Line :
City : MIDDLETOWN
State : OH
Zip : 45044-4117
Country : US
Telephone Number : 513-849-2081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2019
Last Update Date : 06/25/2019

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Directions to “ JESSICA LEA HENIZE ” Practice Location

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