Individual
JESSICA SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8355 BURNS AVE, CINCINNATI, OH 45216
(513) 607-2353
Mailing address
8355 BURNS AVE, CINCINNATI, OH 45216
(513) 607-2353
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
401778900815
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0154673
MEDICAID PROVIDER
OH
Enumeration date
05/04/2016
Last updated
05/04/2016
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