Healthcare Provider Details

I. General information

NPI: 1437127628
Provider Name (Legal Business Name): JESSICA KAUFMAN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 S MAIN ST
MARION OH
43302-3933
US

IV. Provider business mailing address

264 S MAIN ST
MARION OH
43302-3933
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-2027
  • Fax: 740-382-8022
Mailing address:
  • Phone: 740-387-2027
  • Fax: 740-382-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI10099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: