MEDICARE: JESSICA JAMES DONOHUE LMSW

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
1	104100000X	Social Worker	40858	TX

General Provider Information

NPI Number	:	1124151196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA JAMES DONOHUE LMSW

Provider Business Mailing Address
First Line	:	3304 HARDISTY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3009
Country	:	US
Telephone Number	:	713-828-1420
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1354
Country	:	US
Telephone Number	:	513-345-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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