Provider Demographics
NPI:1033626015
Name:SPELLIS, JACOB THOMAS (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:THOMAS
Last Name:SPELLIS
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2811
Mailing Address - Country:US
Mailing Address - Phone:419-740-3022
Mailing Address - Fax:419-740-3022
Practice Address - Street 1:111 CLINTON ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2811
Practice Address - Country:US
Practice Address - Phone:419-740-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1501034104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker