MEDICARE: JILLIAN LEMKE PSYD

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	103G00000X	Clinical Neuropsychologist	6361002295	MI
2	103TC0700X	Clinical Psychologist	P.08676	OH

General Provider Information

NPI Number	:	1932619392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN LEMKE PSYD

Provider Business Mailing Address
First Line	:	3949 SUNFOREST CT STE 105
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4454
Country	:	US
Telephone Number	:	419-475-9341
Fax Number	:

Provider Business Practice Location Address
First Line	:	3949 SUNFOREST CT STE 105
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4454
Country	:	US
Telephone Number	:	419-475-9341
Fax Number	:	419-474-0095

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

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	09/23/2024

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