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General NPI Number Information
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NPI Number | 1295048809
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Entity Type | Individual
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Provider Name | JENNIFER CHILDERS MSSA, LISW-S
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Gender | Female
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Dates
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Enumeration Date | 07/24/2010
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 8445 MUNSON RD
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City | MENTOR
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State | OH
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Zip | 44060-2410
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Country | US
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Telephone | 216-280-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 W 6TH ST 2G
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City | CLEVELAND
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State | OH
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Zip | 44113-1321
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Country | US
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Telephone | 216-280-0401
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1000236-SUPV
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License Number State | OH
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