| Doctor Name: | JESSICA S DATTA |
| NPI Number: | 1003113150 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LSW |
| License Number: | S0027641 |
| Business Practice Address: | 975 Commerce Dr Perrysburg, OH - 435515228 |
| Business Phone Number: | 4198740274 |
| Business Fax Number: | 4198749960 |
| Mailing Address: | 975 Commerce Dr, PERRYSBURG |
| State: | OH |
| Postal Code: | 435515228 |
| Phone Number: | 4198740274 |
| Fax Number: | 4198749960 |
| NPI Enumeration Date: | 02/24/2011 |
| NPI Last Update Date: | 02/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | S0027641 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |