Provider Demographics
NPI:1972758431
Name:LOWERY, JENNIFER L (PC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:LOWERY
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 WATERBURY CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5310
Mailing Address - Country:US
Mailing Address - Phone:614-584-3835
Mailing Address - Fax:614-586-1879
Practice Address - Street 1:457 WATERBURY CT
Practice Address - Street 2:SUITE E
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5310
Practice Address - Country:US
Practice Address - Phone:614-478-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0700291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional