Healthcare Provider Details

I. General information

NPI: 1578242830
Provider Name (Legal Business Name): BRIANNA JENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 EUCLID AVE
EUCLID OH
44117-1521
US

IV. Provider business mailing address

6107 SCOVILL AVE
CLEVELAND OH
44104-1916
US

V. Phone/Fax

Practice location:
  • Phone: 855-967-2436
  • Fax:
Mailing address:
  • Phone: 440-622-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: