Healthcare Provider Details

I. General information

NPI: 1699592642
Provider Name (Legal Business Name): JESSICA KLETT MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 513-349-8735
  • Fax:
Mailing address:
  • Phone: 614-366-8700
  • Fax: 614-685-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: