1457376857 NPI number — MS. JEAN E MILLIKEN SABOL LISW

Table of content: MS. JEAN E MILLIKEN SABOL LISW (NPI 1457376857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457376857 NPI number — MS. JEAN E MILLIKEN SABOL LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLIKEN SABOL
Provider First Name:
JEAN
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLIKEN
Provider Other First Name:
JEAN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457376857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 SOUTH COURT ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-723-7977
Provider Business Mailing Address Fax Number:
330-725-5177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11565 PEARL ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
STRONGSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-846-0862
Provider Business Practice Location Address Fax Number:
440-846-0890
Provider Enumeration Date:
07/13/2006

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:  R0538331 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: I0600123 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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