Provider Demographics
NPI:1821975939
Name:POWELL, JENNIFER S
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:POWELL
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 1:1760 BENEDICT RD
Mailing Address - Street 2:
Mailing Address - City:FLEMING
Mailing Address - State:OH
Mailing Address - Zip Code:45729-5249
Mailing Address - Country:US
Mailing Address - Phone:740-629-7561
Mailing Address - Fax:740-629-7561
Practice Address - Street 1:1760 BENEDICT RD
Practice Address - Street 2:
Practice Address - City:FLEMING
Practice Address - State:OH
Practice Address - Zip Code:45729-5249
Practice Address - Country:US
Practice Address - Phone:740-629-7561
Practice Address - Fax:740-629-7561
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency