Healthcare Provider Details

I. General information

NPI: 1538179254
Provider Name (Legal Business Name): JENNY LEE BEISNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST STE C
GREENVILLE OH
45331-1396
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1186
US

V. Phone/Fax

Practice location:
  • Phone: 937-547-2319
  • Fax: 937-548-4248
Mailing address:
  • Phone: 937-548-3806
  • Fax: 937-548-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004484A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: