Basic Information
| Provider Information | |||||||||
| NPI: | 1730620147 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JETTERS | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 532 MAXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135592072 | ||||||||
| FaxNumber: | 5135592009 | ||||||||
| Practice Location | |||||||||
| Address1: | 532 MAXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135592072 | ||||||||
| FaxNumber: | 5135592009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2017 | ||||||||
| LastUpdateDate: | 03/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 5413 | OH | N | Behavioral Health & Social Service Providers | Psychologist | 103TA0400X | 5413 | OH | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0700X | 5413 | OH | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TB0200X | 5413 | OH | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 5413 | OH | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | 5413 | OH | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TH0100X | 5413 | OH | N | Behavioral Health & Social Service Providers | Psychologist | Health Service | 103TR0400X | 5413 | OH | N | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
No ID Information.