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NPI Code Detail

MEDICARE: MS. JENNIFER JILL WALTER MSW, LISW

MEDICARE: MS. JENNIFER JILL WALTER MSW, LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.1100185OH
21041C0700XClinical Social WorkerI.1100185-SUPVOH

General Provider Information

NPI Number : 1043564123
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER JILL WALTER MSW, LISW
Provider Business Mailing Address
First Line : 1031 HAMPSHIRE RD
Second Line :
City : DAYTON
State : OH
Zip : 45419-3714
Country : US
Telephone Number : 937-867-6129
Fax Number :
Provider Business Practice Location Address
First Line : 1349 E STROOP RD
Second Line :
City : DAYTON
State : OH
Zip : 45429-4925
Country : US
Telephone Number : 937-293-1115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2012
Last Update Date : 08/27/2025

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