Provider Demographics
NPI:1013208396
Name:WHITEHEAD, MARKUS JEZERSKI (BSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:JEZERSKI
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:BSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W BANCROFT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1311
Mailing Address - Country:US
Mailing Address - Phone:419-578-2525
Mailing Address - Fax:
Practice Address - Street 1:2525 W BANCROFT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-1311
Practice Address - Country:US
Practice Address - Phone:419-578-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0017916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker