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General NPI Number Information
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NPI Number | 1194851634
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Entity Type | Individual
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Provider Name | JESSICA RENA CAMPBELL PCC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7843 LAUREL AVE
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City | MADEIRA
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State | OH
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Zip | 45243-2608
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Country | US
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Telephone | 513-561-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 5838 HIGHVIEW DR
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City | MILFORD
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State | OH
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Zip | 45150-2038
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Country | US
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Telephone | 513-305-1437
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0500044
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License Number State | OH
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