Healthcare Provider Details

I. General information

NPI: 1417747809
Provider Name (Legal Business Name): JENNIFER ELIZABETH REAM LPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8044 MONTGOMERY RD STE 120
CINCINNATI OH
45236-2919
US

IV. Provider business mailing address

8044 MONTGOMERY RD STE 120
CINCINNATI OH
45236-2919
US

V. Phone/Fax

Practice location:
  • Phone: 513-607-5128
  • Fax:
Mailing address:
  • Phone: 513-607-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAPS.005877
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005877
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: