Healthcare Provider Details

I. General information

NPI: 1225680291
Provider Name (Legal Business Name): MRS. JACKIE THOMASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 READING RD
CINCINNATI OH
45237-6107
US

IV. Provider business mailing address

4721 READING RD
CINCINNATI OH
45237-6107
US

V. Phone/Fax

Practice location:
  • Phone: 513-653-0907
  • Fax:
Mailing address:
  • Phone: 513-653-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS.2004736
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberS.2004736
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS.2004736
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: