| Jennifer Fenske-doyle Msw Lisw-s Llc | |
|
1055 E Centerville Station Rd Dayton OH 45459-5500 | |
| (937) 439-2984 | |
| (937) 439-2984 |
| Full Name | Jennifer Fenske-doyle Msw Lisw-s Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1055 E Centerville Station Rd, Dayton, Ohio |
| Authorized Official Name and Position | Jennifer Fenske-doyle (SOLE MEMBER) |
| Authorized Official Contact | 9374392984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Fenske-doyle Msw Lisw-s Llc 1055 E Centerville Station Rd Dayton OH 45459-5500 Ph: (937) 439-2984 | Jennifer Fenske-doyle Msw Lisw-s Llc 1055 E Centerville Station Rd Dayton OH 45459-5500 Ph: (937) 439-2984 |
| NPI Number | 1205208121 |
|---|---|
| Provider Enumeration Date | 10/30/2015 |
| Last Update Date | 01/19/2023 |
| Certification Date | 01/19/2023 |
| Medicare PECOS PAC ID | 1951601376 |
|---|---|
| Medicare Enrollment ID | O20151207002661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205208121 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | I.0009170-SUPV (Ohio) | Primary |
| Provider Name | Jennifer Kristen Fenske-doyle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558391805 PECOS PAC ID: 0648201608 Enrollment ID: I20050830000158 |
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