Provider Demographics
NPI:1093354987
Name:URQUHART, JADA LYNN (LISW)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:LYNN
Last Name:URQUHART
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 COUNTY ROAD 24
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9314
Mailing Address - Country:US
Mailing Address - Phone:419-864-3232
Mailing Address - Fax:
Practice Address - Street 1:670 MARION WILLIAMSPORT RD E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8683
Practice Address - Country:US
Practice Address - Phone:740-387-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-25
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19019821041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical