Jennifer Marie Fackelman

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

S.0901179 Issued in OH

Practice address

1822 Cherry St
Toledo, OH 43608-2801

Phone

(419) 720-9247

NPI assigned

Jul 11, 2012

Last updated

Apr 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• A Peace of Mind Wellness LLC

  • Community/Behavioral Health Agency
  • Toledo, OH
  • NPI 1295320786
  Medicare reassignment NPD Authorized official
• A Peace of Mind Wellness LLC

  • Addiction (Substance Use Disorder) Counselor
  • Toledo, OH
  • NPI 1750966982
  NPD Authorized official
• Beach House, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Toledo, OH
  • NPI 1184230906
  NPD

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587686400000",
    "number": "1578828984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2283 ASHLAND AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436201205",
            "telephone_number": "419-244-2175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1822 CHERRY ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436082801",
            "telephone_number": "419-720-9247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKELMAN",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S.0901179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Saundra Ezell, QMHS
• Shalonda C Ezell
• F H Medical Inc
• Lisa Elaine Faber
• William Facey, MD
• Emily Fackler
• Eveon Fadell
• Shabrionna Fadzl
• Jane Lily Faehnle, P.T.
• Anthonyesha Fagan

• Clinical Social Worker in Toledo, OH
• Providers in Toledo, 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 Apr 24, 2020; 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.