Healthcare Provider Details

I. General information

NPI: 1417021999
Provider Name (Legal Business Name): JENNIFER ANN SMITH M.ED., PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6184 LINWORTH RD
WORTHINGTON OH
43085-2812
US

IV. Provider business mailing address

6 COVENTRY LN
ATHENS OH
45701-3716
US

V. Phone/Fax

Practice location:
  • Phone: 614-407-4589
  • Fax:
Mailing address:
  • Phone: 614-670-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE 0501056
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: