Provider Demographics
NPI:1538179254
Name:BEISNER, JENNY LEE
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LEE
Last Name:BEISNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1186
Mailing Address - Country:US
Mailing Address - Phone:937-548-3806
Mailing Address - Fax:937-548-2087
Practice Address - Street 1:1101 JACKSON ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1396
Practice Address - Country:US
Practice Address - Phone:937-547-2319
Practice Address - Fax:937-548-4248
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004484A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN541910E9Medicare PIN
IN231230IIMedicare ID - Type UnspecifiedBEISNERMEDICARERURAL