Healthcare Provider Details

I. General information

NPI: 1093231367
Provider Name (Legal Business Name): WILNEISHA CHARRON JAKES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WILNEISHA CHARRON JAKES LMSW

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MADISON AVE STE 200
TOLEDO OH
43604-1230
US

IV. Provider business mailing address

3033 BARDIN RD APT 105
GRAND PRAIRIE TX
75052-3859
US

V. Phone/Fax

Practice location:
  • Phone: 567-312-8700
  • Fax:
Mailing address:
  • Phone: 504-330-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512618
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12377
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number12377
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: