Provider Demographics
NPI:1043652373
Name:JAKSE, ANNETTE (LSW, LPC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:JAKSE
Suffix:
Gender:F
Credentials:LSW, LPC
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1909 E. 101ST ST.
Mailing Address - Street 2:CLEVELAND SIGHT CENTER
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106
Mailing Address - Country:US
Mailing Address - Phone:216-791-8118
Mailing Address - Fax:216-791-1101
Practice Address - Street 1:1909 E. 101ST ST.
Practice Address - Street 2:CLEVELAND SIGHT CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-791-8118
Practice Address - Fax:216-791-1101
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0005503104100000X
OH0000931104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker