Healthcare Provider Details

I. General information

NPI: 1861045569
Provider Name (Legal Business Name): JILL MARIE CHOLENSKY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7059 WEST BLVD APT 232
YOUNGSTOWN OH
44512-4333
US

IV. Provider business mailing address

7059 WEST BLVD APT 232
YOUNGSTOWN OH
44512-4333
US

V. Phone/Fax

Practice location:
  • Phone: 234-600-8200
  • Fax: 614-826-7577
Mailing address:
  • Phone: 234-600-8200
  • Fax: 614-826-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: