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General NPI Number Information
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NPI Number | 1669988440
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Entity Type | Individual
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Provider Name | JENNIFER A PETERS LISW-S
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Gender | Female
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Dates
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Enumeration Date | 12/16/2017
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 1490 E MAIN ST
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City | COLUMBUS
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State | OH
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Zip | 43205-2140
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Country | US
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Telephone | 614-252-0731
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Fax |
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Provider Business Mailing Address
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Address Line | 5555 WATERLOO RD
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-9542
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Country | US
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Telephone | 614-395-5160
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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-0008967
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License Number State | OH
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