| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JACLYN JOHNSON | 1598271173 | 2021-10-10 |
Jaclyn Johnson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1598271173. Registration indicates Jaclyn Johnson is a provider of services with a specialization in Other Service Providers, Case Manager/Care Coordinator (Case Manager/Care Coordinator, ) (All Other Specialties & Provider Types, ) (Case Manager/Care Coordinator, Other Service Providers)
| Entity Type | Individual |
| Provider Name | Jaclyn Johnson QMHS |
| Practice Office Address | 7232 JUSTIN WAY MENTOR, OH US |
| Practice Office Telephone | 4405788200 |
| Mailing Address | 7232 JUSTIN WAY MENTOR, OH 440604881 US |
| Business Telephone | 4405788200 |
| Code | Practice | License No State |
|---|---|---|
| 171M00000X PRIMARY | Other Service Providers Case Manager/Care Coordinator Case Manager/Care Coordinator All Other Specialties & Provider Types Case Manager/Care Coordinator Other Service Providers | |
| 193200000X MULT | Group Code |
| 0282351 | MEDICAID | OH |