MEDICARE: JACQUELINE MICHELLE WINTER

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	101YM0800X	Mental Health Counselor	C.2305189	OH

General Provider Information

NPI Number	:	1841941994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MICHELLE WINTER

Provider Business Mailing Address
First Line	:	2275 STATE ROUTE 59
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-7143
Country	:	US
Telephone Number	:	440-821-5081
Fax Number	:

Provider Business Practice Location Address
First Line	:	2275 STATE ROUTE 59
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-7143
Country	:	US
Telephone Number	:	330-593-5959
Fax Number	:

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

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	06/12/2023

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Directions to “ JACQUELINE MICHELLE WINTER ” Practice Location

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