Healthcare Provider Details

I. General information

NPI: 1780320275
Provider Name (Legal Business Name): JESSICA WARTH SWA, REV, M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 E MAIN ST STE B
CHILLICOTHEE OH
45601-3509
US

IV. Provider business mailing address

273 CHIEF LN
CHILLICOTHEE OH
45601-7008
US

V. Phone/Fax

Practice location:
  • Phone: 740-804-6800
  • Fax: 740-721-4155
Mailing address:
  • Phone: 740-637-2996
  • Fax: 740-721-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2411735
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: