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NPI Code Detail

MEDICARE: JILL L. DICKIE LISW-SUPV

MEDICARE: JILL L. DICKIE LISW-SUPV
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.0000437OH
21041C0700XClinical Social WorkerI.0000437-SUPVOH

General Provider Information

NPI Number : 1184850323
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL L. DICKIE LISW-SUPV
Provider Business Mailing Address
First Line : 5982 RHODES RD
Second Line :
City : KENT
State : OH
Zip : 44240-4128
Country : US
Telephone Number : 330-673-1347
Fax Number : 330-678-3677
Provider Business Practice Location Address
First Line : 3922 LOVERS LN
Second Line :
City : RAVENNA
State : OH
Zip : 44266-4200
Country : US
Telephone Number : 330-673-1347
Fax Number : 330-678-3677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2009
Last Update Date : 06/02/2009

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