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NPI Code Detail

MEDICARE: JESSICA RENE MICHELS LISW

MEDICARE: JESSICA RENE MICHELS LISW
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 15000443OH
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1811367014
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RENE MICHELS LISW
Provider Business Mailing Address
First Line : 2386 E RAHN RD
Second Line :
City : DAYTON
State : OH
Zip : 45440-2518
Country : US
Telephone Number : 937-264-0084
Fax Number : 937-264-0095
Provider Business Practice Location Address
First Line : 1785 BIG HILL RD
Second Line :
City : DAYTON
State : OH
Zip : 45439-2219
Country : US
Telephone Number : 937-830-5313
Fax Number : 937-264-0095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2015
Last Update Date : 05/10/2024

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