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NPI Code Detail

MEDICARE: DR. VANESSA LEE JETTERS PSY.D

MEDICARE: DR. VANESSA LEE JETTERS PSY.D
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
1103T00000XPsychologist5413OH
2103TA0400XAddiction (Substance Use Disorder) Psychologist5413OH
3103TA0700XAdult Development & Aging Psychologist5413OH
4103TB0200XCognitive & Behavioral Psychologist5413OH
5103TC0700XClinical Psychologist5413OH
6103TC1900XCounseling Psychologist5413OH
7103TH0100XHealth Service Psychologist5413OH
8103TR0400XRehabilitation Psychologist5413OH

General Provider Information

NPI Number : 1730620147
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VANESSA LEE JETTERS PSY.D
Provider Business Mailing Address
First Line : 532 MAXWELL AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-2408
Country : US
Telephone Number : 513-559-2072
Fax Number : 513-559-2009
Provider Business Practice Location Address
First Line : 532 MAXWELL AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-2408
Country : US
Telephone Number : 513-559-2072
Fax Number : 513-559-2009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2017
Last Update Date : 03/17/2017

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