Healthcare Provider Details

I. General information

NPI: 1124575949
Provider Name (Legal Business Name): LINDA MARIE FISHER-JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 E STROOP RD
KETTERING OH
45429-4925
US

IV. Provider business mailing address

557 STONECROFT DR
SPRINGFIELD OH
45502-8377
US

V. Phone/Fax

Practice location:
  • Phone: 937-258-4244
  • Fax:
Mailing address:
  • Phone: 937-258-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS.1100279
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: