Healthcare Provider Details

I. General information

NPI: 1235925637
Provider Name (Legal Business Name): JENNIFER CLEMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 MADISON RD APT 21B
CINCINNATI OH
45227-1675
US

IV. Provider business mailing address

11361 VILLAGE BROOK DR APT 1716
CINCINNATI OH
45249-2081
US

V. Phone/Fax

Practice location:
  • Phone: 727-485-5522
  • Fax:
Mailing address:
  • Phone: 727-505-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: