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NPI Code Detail

MEDICARE: JACQUELYN SUE ALLISON PEER SUPPORT SPECIAL

MEDICARE: JACQUELYN SUE ALLISON PEER SUPPORT SPECIAL
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
1175T00000XPeer Specialist1355OH
2171M00000XCase Manager/Care CoordinatorCDCA.185310OH
3101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.185310OH

General Provider Information

NPI Number : 1295388452
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN SUE ALLISON PEER SUPPORT SPECIAL
Provider Business Mailing Address
First Line : 77 E WOODBURY DR STE 110
Second Line :
City : DAYTON
State : OH
Zip : 45415-2853
Country : US
Telephone Number : 937-789-2519
Fax Number :
Provider Business Practice Location Address
First Line : 77 E WOODBURY DR STE 110
Second Line :
City : DAYTON
State : OH
Zip : 45415-2853
Country : US
Telephone Number : 937-972-8455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2019
Last Update Date : 10/28/2025

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