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NPI Code Detail

MEDICARE: JACQUELYNN JAE WILLIAMS

MEDICARE: JACQUELYNN JAE WILLIAMS
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
11041C0700XClinical Social WorkerI.2102890OH

General Provider Information

NPI Number : 1346655206
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYNN JAE WILLIAMS
Provider Business Mailing Address
First Line : 4159 N HOLLAND SYLVANIA RD STE 205
Second Line :
City : TOLEDO
State : OH
Zip : 43623-4801
Country : US
Telephone Number : 419-318-5286
Fax Number :
Provider Business Practice Location Address
First Line : 4159 N HOLLAND SYLVANIA RD STE 205
Second Line :
City : TOLEDO
State : OH
Zip : 43623-4801
Country : US
Telephone Number : 419-318-5286
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 07/07/2021

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