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General NPI Number Information
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NPI Number | 1083101281
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Entity Type | Individual
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Provider Name | JAMIE WYNN
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Gender | Female
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 165 E PARK AVE
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City | NILES
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State | OH
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Zip | 44446-2352
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Country | US
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Telephone | 330-544-8005
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Fax |
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Provider Business Mailing Address
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Address Line | 1148 EASTFIELD RD
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City | WORTHINGTON
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State | OH
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Zip | 43085-3206
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Country | US
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Telephone | 614-561-4646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1701670
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License Number State | OH
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