Healthcare Provider Details

I. General information

NPI: 1982175931
Provider Name (Legal Business Name): JESSICA HAYS LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2963 BLUE JACKET CT STE B
LIMA OH
45806-1464
US

IV. Provider business mailing address

2963 BLUE JACKET CT STE B
LIMA OH
45806-1464
US

V. Phone/Fax

Practice location:
  • Phone: 419-581-9138
  • Fax:
Mailing address:
  • Phone: 419-581-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0700384
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: