Holly Jedlicka, MSW, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1000061 Issued in OH

Practice address

9800 Jug St NW
Pataskala, OH 43062-8691

Phone

(614) 395-1395

Fax

(740) 927-1516

NPI assigned

Sep 25, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Group practices

PBJ Connections IncGroup PAC ID 1456613967, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• PBJ Connections, Inc.

  • Clinical Social Worker
  • Pataskala, OH
  • NPI 1821302654
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1033460480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92",
            "city": "KIRKERSVILLE",
            "state": "OH",
            "postal_code": "430330092",
            "telephone_number": "614-395-1395",
            "fax_number": "740-927-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9800 JUG ST NW",
            "city": "PATASKALA",
            "state": "OH",
            "postal_code": "430628691",
            "telephone_number": "614-395-1395",
            "fax_number": "740-927-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEDLICKA",
        "first_name": "HOLLY",
        "credential": "MSW, LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-25",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "1000061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nafisa Ibrahim, RN
• Indreni Home Care LLC
• Tiffany E.D. Inglis, M.D.
• Robin Jacobson
• Jas New Dimensions LLC
• Connie S Jenkins, MD
• Jon Fouts Dba Horizons East LLC
• Julia a. Allerton
• Anissa Kasarjian, LISW
• Kaye Maynard Counseling Inc

• Clinical Social Worker in Pataskala, OH
• Providers in Pataskala, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.