MEDICARE: JALEA CALDWELL

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1497210728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALEA CALDWELL

Provider Business Mailing Address
First Line	:	11 CALHOUN RD
Second Line	:
City	:	THURMAN
State	:	OH
Zip	:	45685-7508
Country	:	US
Telephone Number	:	740-645-8064
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 CALHOUN RD
Second Line	:
City	:	THURMAN
State	:	OH
Zip	:	45685-7508
Country	:	US
Telephone Number	:	740-645-8064
Fax Number	:

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

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	12/02/2022

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