Jerry Ryan Hackley III, MSW, LSW
Individual provider Active NPI Social Worker · Seville, OH
NPI 1992289417 · NPPES record last updated May 22, 2019
Key facts
- NPI
- 1992289417
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- S.1903598 (OH)
- Practice address
- 269 Center St
Seville, OH 44273-8864 - Phone
- (330) 591-4648
- NPI assigned
- Sep 20, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.1903598 | OH | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.1903598 | OH | Yes |
Addresses
Primary practice location
269 Center St
Seville, OH 44273-8864
Mailing address
269 Center St
Seville, OH 44273-8864
Phone (330) 591-4648
Other providers in Seville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.