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NPI Code Detail

MEDICARE: JACQUELINE L RICHARDSON

MEDICARE: JACQUELINE L RICHARDSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2101YA0400XAddiction (Substance Use Disorder) Counselor165933OH

General Provider Information

NPI Number : 1063911204
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE L RICHARDSON
Provider Business Mailing Address
First Line : 310 HAYES AVE
Second Line :
City : FREMONT
State : OH
Zip : 43420-3002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 MADISON AVE STE 300
Second Line :
City : TOLEDO
State : OH
Zip : 43604-1257
Country : US
Telephone Number : 567-312-8700
Fax Number : 567-312-8700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2018
Last Update Date : 03/11/2020

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Directions to “ JACQUELINE L RICHARDSON ” Practice Location

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