=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972269736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SJP THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2021
-----------------------------------------------------
Last Update Date | 11/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10999 REED HARTMAN HWY STE 337
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-788-2357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10999 REED HARTMAN HWY STE 337
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-788-2357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SAMANTHA PEASE
-----------------------------------------------------
Credential | MSW, LISW-S
-----------------------------------------------------
Telephone | 330-506-3981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------