Provider Demographics
NPI:1114227311
Name:LAYNE, JO ELLEN (LISW-S)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:LAYNE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2745
Mailing Address - Country:US
Mailing Address - Phone:937-760-0268
Mailing Address - Fax:
Practice Address - Street 1:2219 ACORN DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45419-2745
Practice Address - Country:US
Practice Address - Phone:937-898-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00088341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical