MEDICARE: MS. JACQUELINE NICOLE DOVER MSSA, LSW

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
1	1041S0200X	School Social Worker	S.1000326	OH

General Provider Information

NPI Number	:	1487953980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE NICOLE DOVER MSSA, LSW

Provider Business Mailing Address
First Line	:	17599 WATERBRIDGE DR
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-6467
Country	:	US
Telephone Number	:	440-390-1730
Fax Number	:

Provider Business Practice Location Address
First Line	:	17599 WATERBRIDGE DR
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-6467
Country	:	US
Telephone Number	:	440-390-1730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	03/23/2011

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