Active NPI
Jackie Lynn Ann Wiley, LSW
- Social Worker
- Wooster, OH
National Provider Identifier
1538840152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.2308934
- Practice address
- 104 Spink St
Wooster, OH 44691-3652 - Phone
- (330) 264-8498
- NPI assigned
- Jul 27, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.2308934 | OH | Primary |
Addresses
Primary practice location
104 Spink St
Wooster, OH 44691-3652
Mailing address
117 W Middle St
Burbank, OH 44214-9777
Phone (330) 407-1794
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.2308934 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1538840152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 W MIDDLE ST",
"city": "BURBANK",
"state": "OH",
"postal_code": "442149777",
"telephone_number": "330-407-1794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 SPINK ST",
"city": "WOOSTER",
"state": "OH",
"postal_code": "446913652",
"telephone_number": "330-264-8498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILEY",
"first_name": "JACKIE",
"middle_name": "LYNN ANN",
"name_prefix": "Ms.",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-27",
"last_updated": "2023-07-27",
"certification_date": "2023-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2308934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wooster, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.