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General NPI Number Information
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NPI Number | 1194736066
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Entity Type | Individual
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Provider Name | JAMIE M WINTUCKY LISW-S
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Gender | Female
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 24197 BROADWAY AVE
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146-6330
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Country | US
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Telephone | 216-707-7901
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Fax |
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Provider Business Mailing Address
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Address Line | 7391 WELLINGTON CT
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City | BOSTON HEIGHTS
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State | OH
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Zip | 44236-1159
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Country | US
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Telephone | 440-668-9536
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I0009717
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I9717
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License Number State | OH
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