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General NPI Number Information
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NPI Number | 1962167601
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Entity Type | Individual
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Provider Name | JEANNIE KINZER CDCA
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Gender | Female
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 4300 OLD SCIOTO TRL
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City | PORTSMOUTH
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State | OH
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Zip | 45662-6642
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Country | US
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Telephone | 740-351-9298
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Fax | 740-529-0553
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Provider Business Mailing Address
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Address Line | 29084 US 23 HWY APT 4
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City | SOUTH SHORE
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State | KY
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Zip | 41175-9727
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Country | US
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Telephone | 740-935-8860
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 178583
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License Number State | OH
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