Healthcare Provider Details

I. General information

NPI: 1154130433
Provider Name (Legal Business Name): JACQUELINE WHITNEY PEELLE CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRIANGLE PARK DR
CINCINNATI OH
45246-3423
US

IV. Provider business mailing address

1 TRIANGLE PARK DR
CINCINNATI OH
45246-3423
US

V. Phone/Fax

Practice location:
  • Phone: 740-895-0519
  • Fax: 866-542-4862
Mailing address:
  • Phone: 740-895-0519
  • Fax: 866-542-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: