Provider Demographics
NPI:1104098268
Name:SIMON, JENNIFER L (MSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:6200 SOM CENTER RD
Mailing Address - Street 2:SUITE D-20
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2944
Mailing Address - Country:US
Mailing Address - Phone:216-502-3325
Mailing Address - Fax:
Practice Address - Street 1:6200 SOM CENTER RD
Practice Address - Street 2:SUITE D-20
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2944
Practice Address - Country:US
Practice Address - Phone:216-502-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0010051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical