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General NPI Number Information
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NPI Number | 1932619392
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Entity Type | Individual
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Provider Name | JILLIAN LEMKE PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 3949 SUNFOREST CT STE 105
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City | TOLEDO
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State | OH
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Zip | 43623-4454
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Country | US
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Telephone | 419-475-9341
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Fax | 419-474-0095
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Provider Business Mailing Address
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Address Line | 3949 SUNFOREST CT STE 105
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City | TOLEDO
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State | OH
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Zip | 43623-4454
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Country | US
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Telephone | 419-475-9341
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6361002295
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P.08676
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License Number State | OH
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