Provider Demographics
NPI:1427191642
Name:SIEHL, JONATHAN CARL (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CARL
Last Name:SIEHL
Suffix:
Gender:M
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 KENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3611
Mailing Address - Country:US
Mailing Address - Phone:614-668-3344
Mailing Address - Fax:614-505-6876
Practice Address - Street 1:1000 HIGH ST
Practice Address - Street 2:SUITE D
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4044
Practice Address - Country:US
Practice Address - Phone:614-668-3344
Practice Address - Fax:614-505-6876
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-1298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1-9H-7857OtherHORIZON HEALTH
OH0004599472OtherAETNA
OH062957000OtherMAGELLAN
SISW11843OtherMEDICARE ID - TYPE UNSPECIFIED
OH062957000OtherMAGELLAN