Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 5413 | OH |
N | 103T00000X | Psychologist | 5413 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 5413 | OH |
N | 103TA0700X | Adult Development & Aging Psychologist | 5413 | OH |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 5413 | OH |
Y | 103G00000X | Clinical Psychologist | 5413 | OH |
Y | 103TC0700X | Clinical Psychologist | 5413 | OH |
N | 103TC1900X | Counseling Psychologist | 5413 | OH |
N | 103TH0100X | Health Service | 5413 | OH |
N | 103TR0400X | Rehabilitation Psychologist | 5413 | OH |
NPI | 1730620147 |
---|---|
Provider Name | Dr. Vanessa Lee Jetters |
First Address | Cincinnati, OH 45219-2408 |
Second Address | Cincinnati, OH 45219-2408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2017 |
Last Update Date | 17/03/2017 |