Healthcare Provider Details

I. General information

NPI: 1356110514
Provider Name (Legal Business Name): JEANETTE MARIE KNIPFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S MAIN ST
DAYTON OH
45402-2708
US

IV. Provider business mailing address

660 S MAIN ST
DAYTON OH
45402-2708
US

V. Phone/Fax

Practice location:
  • Phone: 937-510-2507
  • Fax:
Mailing address:
  • Phone: 937-510-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: