Basic Information
| Provider Information | |||||||||
| NPI: | 1306920681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLETCHER | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.I.S.W.-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 S TAFT AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434203237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193346619 | ||||||||
| FaxNumber: | 4193346663 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 E MAIN CROSS ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458406381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194241471 | ||||||||
| FaxNumber: | 4194241413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 01/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I0005577 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0100801 | 05 | OH | MEDICAID |