Individual
JENNIFER BURNSIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDCIII
Contact information
Practice address
777 COLUMBUS AVE, LEBANON, OH 45036-1684
(513) 228-6590
Mailing address
777 COLUMBUS AVE, LEBANON, OH 45036-1684
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
991509
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4752702
—
OH
Enumeration date
02/20/2019
Last updated
02/20/2019
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