Healthcare Provider Details

I. General information

NPI: 1285248203
Provider Name (Legal Business Name): JACQUELINE DELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE DUC LPC

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 GATEWAY STE 101
MASON OH
45040-1893
US

IV. Provider business mailing address

5740 GATEWAY STE 101
MASON OH
45040-1893
US

V. Phone/Fax

Practice location:
  • Phone: 513-549-1598
  • Fax:
Mailing address:
  • Phone: 513-549-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.2607065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: