Healthcare Provider Details

I. General information

NPI: 1699020826
Provider Name (Legal Business Name): JENNIFER MARIE SMALL LSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 CINCINNATI BATAVIA PIKE
CINCINNATI OH
45244-1518
US

IV. Provider business mailing address

3332 BLUEACRES DR APT 3
CINCINNATI OH
45239-6160
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 513-518-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: