=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326765967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYNA KENNEDY MSW, LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2022
-----------------------------------------------------
Last Update Date | 10/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2575 OLDE FALLS RD
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-8731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-260-4081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2845 BELL ST
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-454-9766
-----------------------------------------------------
Fax | 740-588-6452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | S.0027503
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------