Active NPI
Jerry Ryan Hackley III, MSW, LSW
- Social Worker
- Seville, OH
National Provider Identifier
1992289417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.1903598
- Practice address
- 269 Center St
Seville, OH 44273-8864 - Phone
- (330) 591-4648
- NPI assigned
- Sep 20, 2018
- Last updated
- May 22, 2019
- Sex
- Male
- 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.1903598 | OH | Primary |
Addresses
Primary practice location
269 Center St
Seville, OH 44273-8864
Mailing address
269 Center St
Seville, OH 44273-8864
Phone (330) 591-4648
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.1903598 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558483200000",
"number": "1992289417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "269 CENTER ST",
"city": "SEVILLE",
"state": "OH",
"postal_code": "442738864",
"telephone_number": "330-591-4648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "269 CENTER ST",
"city": "SEVILLE",
"state": "OH",
"postal_code": "442738864",
"telephone_number": "330-591-4648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKLEY",
"first_name": "JERRY",
"middle_name": "RYAN",
"name_suffix": "III",
"credential": "MSW, LSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-20",
"last_updated": "2019-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.1903598",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.