Basic Information
| Provider Information | |||||||||
| NPI: | 1851918429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORNLIN | ||||||||
| FirstName: | SALLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10212 EASTERDAY CT | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217429775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405000421 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8504 MAPLEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BOONSBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217131817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017339067 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2020 | ||||||||
| LastUpdateDate: | 06/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 20387 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.