Provider Demographics
NPI:1235376823
Name:JAY, MONICA SUE (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:SUE
Last Name:JAY
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 1:317 BIRCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3011
Mailing Address - Country:US
Mailing Address - Phone:419-680-0937
Mailing Address - Fax:
Practice Address - Street 1:317 BIRCHARD AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3011
Practice Address - Country:US
Practice Address - Phone:419-680-0937
Practice Address - Fax:567-249-0067
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OH08001491041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
271562089004OtherBC#
OH0530447Medicaid
OH0530447Medicaid