Healthcare Provider Details

I. General information

NPI: 1457376857
Provider Name (Legal Business Name): JEAN E MILLIKEN SABOL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN E MILLIKEN LCSW

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 PEARL ROAD SUITE 200
STRONGSVILLE OH
44136
US

IV. Provider business mailing address

230 SOUTH COURT ST SUITE 5
MEDINA OH
44256
US

V. Phone/Fax

Practice location:
  • Phone: 440-846-0862
  • Fax: 440-846-0890
Mailing address:
  • Phone: 330-723-7977
  • Fax: 330-725-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0538331
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI0600123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: