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General NPI Number Information
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NPI Number | 1700028800
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Entity Type | Individual
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Provider Name | JACLYN M SCANLAN LISW
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Gender | Female
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Dates
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Enumeration Date | 04/03/2009
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 5350 LAMME RD
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City | MORAINE
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State | OH
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Zip | 45439-3215
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Country | US
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Telephone | 937-534-4632
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Fax | 937-534-4609
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Provider Business Mailing Address
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Address Line | 1532 LITTLE FALLS DR
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City | DAYTON
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State | OH
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Zip | 45458-9707
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Country | US
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Telephone | 315-269-4261
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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 | I0800313
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License Number State | OH
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