Healthcare Provider Details

I. General information

NPI: 1417156696
Provider Name (Legal Business Name): JENNIFER CHANEY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

IV. Provider business mailing address

DEPT 781625 PO BOX 78000
DETROIT MI
48278-1625
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-3841
  • Fax:
Mailing address:
  • Phone: 614-355-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0600560
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: