MEDICARE: JENNIFER KETZER

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	S1201162	OH

General Provider Information

NPI Number	:	1659794055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KETZER

Provider Business Mailing Address
First Line	:	2626 QUARRY LAKE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-4951
Country	:	US
Telephone Number	:	513-368-5054
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 QUARRY LAKE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-4951
Country	:	US
Telephone Number	:	513-368-5054
Fax Number	:

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

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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Directions to “ JENNIFER KETZER ” Practice Location

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