Provider Demographics
NPI:1285877407
Name:WEBB, JENNIFER ALICE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ALICE
Last Name:WEBB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ALICE
Other - Last Name:BURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:785 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1013
Mailing Address - Country:US
Mailing Address - Phone:614-621-3673
Mailing Address - Fax:614-621-9508
Practice Address - Street 1:785 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1013
Practice Address - Country:US
Practice Address - Phone:614-621-3673
Practice Address - Fax:614-621-9508
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist