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General NPI Number Information
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NPI Number | 1184977787
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Entity Type | Individual
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Provider Name | JESSICA ORLOV KETNER M.S., IMFT
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Gender | Female
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 92 NORTHWOODS BLVD SUITE C-2
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City | COLUMBUS
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State | OH
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Zip | 43235-4720
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Country | US
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Telephone | 614-214-1631
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Fax |
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Provider Business Mailing Address
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Address Line | 92 NORTHWOODS BLVD SUITE C-2
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City | COLUMBUS
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State | OH
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Zip | 43235-4720
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Country | US
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Telephone | 614-214-1631
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006459
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | F . 1400010
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License Number State | OH
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