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NPI Code Detail

MEDICARE: JENNIFER MOORE

MEDICARE: JENNIFER MOORE
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
1104100000XSocial WorkerS.16000504OH
2104100000XSocial WorkerI.2102864OH

General Provider Information

NPI Number : 1710523386
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MOORE
Provider Business Mailing Address
First Line : 909 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1105
Country : US
Telephone Number : 513-259-5480
Fax Number :
Provider Business Practice Location Address
First Line : 909 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1105
Country : US
Telephone Number : 513-646-5026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2019
Last Update Date : 03/11/2024

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Directions to “ JENNIFER MOORE ” Practice Location

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