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NPI Code Detail

MEDICARE: JENNIFER COOPER MSW, LISW

MEDICARE: JENNIFER COOPER 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
1104100000XSocial Worker1600608OH

General Provider Information

NPI Number : 1881148443
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER COOPER MSW, LISW
Provider Business Mailing Address
First Line : 2250 PLEASANT AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45015-1135
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2250 PLEASANT AVE
Second Line :
City : HAMILTON
State : OH
Zip : 45015-1135
Country : US
Telephone Number : 513-868-4868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2016
Last Update Date : 08/11/2016

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