1417214032 NPI number — MRS. JACQUELINE C CARVER LISW-S

Table of content: MRS. JACQUELINE C CARVER LISW-S (NPI 1417214032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417214032 NPI number — MRS. JACQUELINE C CARVER LISW-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARVER
Provider First Name:
JACQUELINE
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417214032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 STATE ROUTE 61
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTLINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44827-9451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-617-9173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W CHARLES ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCYRUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44820-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-617-1140
Provider Business Practice Location Address Fax Number:
419-740-1515
Provider Enumeration Date:
04/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I.1201243 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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