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General NPI Number Information
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NPI Number | 1235521311
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Entity Type | Organization
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Legal Business Name | JULIE B JAEKEL LCSW
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 1225 J G LN
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5768
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Country | US
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Telephone | 850-212-2817
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 J G LN
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5768
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Country | US
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Telephone | 850-212-2817
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JULIE B JAEKEL
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Credential | LCSW
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Telephone | 850-212-2817
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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 | 485
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License Number State | FL
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