Healthcare Provider Details

I. General information

NPI: 1801257027
Provider Name (Legal Business Name): JENNIFER KNIGHT LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 TORRINGTON AVE # 1
PARMA OH
44134-2177
US

IV. Provider business mailing address

5209 TORRINGTON AVE # 1
PARMA OH
44134-2177
US

V. Phone/Fax

Practice location:
  • Phone: 703-215-8573
  • Fax:
Mailing address:
  • Phone: 703-215-8573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2102674
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: