Provider Demographics
NPI:1215335757
Name:FOLEY, JENNIFER (LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FOLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 CINCINNATI ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-4614
Mailing Address - Country:US
Mailing Address - Phone:937-449-0800
Mailing Address - Fax:937-449-0881
Practice Address - Street 1:1435 CINCINNATI ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4614
Practice Address - Country:US
Practice Address - Phone:937-449-0800
Practice Address - Fax:937-449-0881
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0022730101Y00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst