Healthcare Provider Details

I. General information

NPI: 1689432601
Provider Name (Legal Business Name): JENNIFER LYNN DELANCEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BLACKLICK EASTERN RD
PICKERINGTON OH
43147-8235
US

IV. Provider business mailing address

5300 HIGHVIEW DR
ZANESVILLE OH
43701-9755
US

V. Phone/Fax

Practice location:
  • Phone: 740-297-0220
  • Fax:
Mailing address:
  • Phone: 740-297-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberS.2208540
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: