Provider Demographics
NPI:1366978488
Name:PARKS, JESSICA (LISW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 GLENSPRINGS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2317
Mailing Address - Country:US
Mailing Address - Phone:513-771-9600
Mailing Address - Fax:513-771-2546
Practice Address - Street 1:415 GLENSPRINGS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2317
Practice Address - Country:US
Practice Address - Phone:513-771-9600
Practice Address - Fax:513-771-2546
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16001621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical