Provider Demographics
NPI:1457798274
Name:KINSEY, JESSICA LEE (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEE
Last Name:KINSEY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 HUMMEL VALLEY RD SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-7513
Mailing Address - Country:US
Mailing Address - Phone:330-432-3770
Mailing Address - Fax:
Practice Address - Street 1:278 HUMMEL VALLEY RD SW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-7513
Practice Address - Country:US
Practice Address - Phone:330-432-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI08000281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical