Healthcare Provider Details

I. General information

NPI: 1396663548
Provider Name (Legal Business Name): JENNA MOOREHEAD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1961 OVERLOOK RIDGE DR
COLUMBUS OH
43219-5516
US

IV. Provider business mailing address

1961 OVERLOOK RIDGE DR
COLUMBUS OH
43219-5516
US

V. Phone/Fax

Practice location:
  • Phone: 814-574-6881
  • Fax:
Mailing address:
  • Phone: 814-574-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512496
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: