MEDICARE: JALYSSA LYNNE PARKER

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
2	104100000X	Social Worker	S.2512207	OH

General Provider Information

NPI Number	:	1740768969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALYSSA LYNNE PARKER

Provider Business Mailing Address
First Line	:	4352 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3463
Country	:	US
Telephone Number	:	844-561-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	4352 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3463
Country	:	US
Telephone Number	:	844-561-5433
Fax Number	:

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

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	06/06/2025

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