Provider Demographics
NPI:1639061914
Name:HENRY, JILLIAN (MS, LISW)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 BURDETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1715
Mailing Address - Country:US
Mailing Address - Phone:313-377-5225
Mailing Address - Fax:
Practice Address - Street 1:5076 WOOSTER RD STE 15
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-2385
Practice Address - Country:US
Practice Address - Phone:513-201-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.24053981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical