Healthcare Provider Details

I. General information

NPI: 1437482163
Provider Name (Legal Business Name): MS. JESSICA FANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 BURNET AVE
CINCINNATI OH
45219-2551
US

IV. Provider business mailing address

1389 POPLARTREE PL
INDEPENDENCE KY
41051-7575
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-0000
  • Fax:
Mailing address:
  • Phone: 513-706-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA10996
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.13069
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: