Individual
JESSICA S DATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
975 COMMERCE DR, PERRYSBURG, OH 43551-5228
(419) 874-0274
(419) 874-9960
Mailing address
975 COMMERCE DR, PERRYSBURG, OH 43551-5228
(419) 874-0274
(419) 874-9960
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
S0027641
OH
Other
Enumeration date
02/24/2011
Last updated
02/24/2011
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