Healthcare Provider Details

I. General information

NPI: 1841109162
Provider Name (Legal Business Name): JESSICA MARIE JAVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8044 MONTGOMERY RD # 120
CINCINNATI OH
45236-2919
US

IV. Provider business mailing address

8044 MONTGOMERY RD # 120
CINCINNATI OH
45236-2919
US

V. Phone/Fax

Practice location:
  • Phone: 419-689-3002
  • Fax:
Mailing address:
  • Phone: 419-689-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.008156
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: