Basic Information
Provider Information | |||||||||
NPI: | 1437720067 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WARD | ||||||||
FirstName: | JANET | ||||||||
MiddleName: | SUE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CHAMBERS | ||||||||
OtherFirstName: | JANET | ||||||||
OtherMiddleName: | SUE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1450 MEADOWVIEW DR APT 2 | ||||||||
Address2: |   | ||||||||
City: | CELINA | ||||||||
State: | OH | ||||||||
PostalCode: | 458224108 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9376949739 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 720 ARMSTRONG ST | ||||||||
Address2: |   | ||||||||
City: | SAINT MARYS | ||||||||
State: | OH | ||||||||
PostalCode: | 458851800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193947451 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/06/2021 | ||||||||
LastUpdateDate: | 07/06/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/06/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X |   | OH | Y |   | Other Service Providers | Case Manager/Care Coordinator |   |
No ID Information.