Healthcare Provider Details

I. General information

NPI: 1730876129
Provider Name (Legal Business Name): SPINISHA SYMONE JETSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2879 JOHNSTOWN RD
COLUMBUS OH
43219-1719
US

IV. Provider business mailing address

2879 JOHNSTOWN RD
COLUMBUS OH
43219-1719
US

V. Phone/Fax

Practice location:
  • Phone: 614-729-8558
  • Fax:
Mailing address:
  • Phone: 614-729-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2507215
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: