Provider Demographics
NPI:1306241849
Name:MURPHY, JENNIFER ROSE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:MURPHY
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 1:541 STATE ROUTE 664 N
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-8541
Mailing Address - Country:US
Mailing Address - Phone:740-385-6594
Mailing Address - Fax:740-385-0852
Practice Address - Street 1:541 STATE ROUTE 664 N
Practice Address - Street 2:SUITE C
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8541
Practice Address - Country:US
Practice Address - Phone:740-385-6594
Practice Address - Fax:740-385-0852
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.14506451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical