Healthcare Provider Details

I. General information

NPI: 1922796903
Provider Name (Legal Business Name): ANNA JEWEL FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SHADY LANE DR
NORWALK OH
44857-2710
US

IV. Provider business mailing address

130 SHADY LANE DR
NORWALK OH
44857-2710
US

V. Phone/Fax

Practice location:
  • Phone: 567-743-7199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608397
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: