Healthcare Provider Details

I. General information

NPI: 1265927206
Provider Name (Legal Business Name): JACQUELINE RENEE GARN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24500 CENTER RIDGE RD STE 125
WESTLAKE OH
44145-5624
US

IV. Provider business mailing address

24500 CENTER RIDGE RD STE 125
WESTLAKE OH
44145-5624
US

V. Phone/Fax

Practice location:
  • Phone: 440-973-6244
  • Fax:
Mailing address:
  • Phone: 440-973-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.2102965
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1501264
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: