Healthcare Provider Details

I. General information

NPI: 1356821581
Provider Name (Legal Business Name): JACQUELINE R NICHOLES BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 ADAIR AVE
ZANESVILLE OH
43701-2843
US

IV. Provider business mailing address

33 S 5TH ST
ZANESVILLE OH
43701-3510
US

V. Phone/Fax

Practice location:
  • Phone: 740-891-9000
  • Fax:
Mailing address:
  • Phone: 740-891-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411446
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: