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General NPI Number Information
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NPI Number | 1770390908
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Entity Type | Individual
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Provider Name | JADE SPATES
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 3648 VICTORY AVE
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City | TOLEDO
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State | OH
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Zip | 43607-2564
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Country | US
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Telephone | 419-277-6982
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Fax |
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Provider Business Mailing Address
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Address Line | 7126 RAMBLEHURST RD
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City | SYLVANIA
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State | OH
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Zip | 43560-3858
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Country | US
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Telephone | 419-277-6982
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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