Healthcare Provider Details

I. General information

NPI: 1083419394
Provider Name (Legal Business Name): JACI JOY LORENGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 FULTON AVE
CINCINNATI OH
45206-2504
US

IV. Provider business mailing address

105 RIDGEWAY AVE
SOUTHGATE KY
41071-3129
US

V. Phone/Fax

Practice location:
  • Phone: 513-713-1484
  • Fax:
Mailing address:
  • Phone: 859-979-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006619
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: