Provider Demographics
NPI:1417575820
Name:GOOD, JEWELL LEIGH (LISW-S)
Entity Type:Individual
Prefix:
First Name:JEWELL
Middle Name:LEIGH
Last Name:GOOD
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:JEWELL
Other - Middle Name:
Other - Last Name:BABISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:8997 HOLLANSBURG SAMPSON RD
Mailing Address - Street 2:
Mailing Address - City:ARCANUM
Mailing Address - State:OH
Mailing Address - Zip Code:45304-8617
Mailing Address - Country:US
Mailing Address - Phone:937-248-7582
Mailing Address - Fax:
Practice Address - Street 1:8997 HOLLANSBURG SAMPSON RD
Practice Address - Street 2:
Practice Address - City:ARCANUM
Practice Address - State:OH
Practice Address - Zip Code:45304-8617
Practice Address - Country:US
Practice Address - Phone:937-248-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-12
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00008979-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical