Healthcare Provider Details

I. General information

NPI: 1205293065
Provider Name (Legal Business Name): JENNIFER LYNN MARPLE LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SUPERIOR ST
SANDUSKY OH
44870-1849
US

IV. Provider business mailing address

420 SUPERIOR ST
SANDUSKY OH
44870-1849
US

V. Phone/Fax

Practice location:
  • Phone: 419-626-5623
  • Fax: 419-626-4824
Mailing address:
  • Phone: 419-626-5623
  • Fax: 419-626-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0800103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: