Provider Demographics
NPI:1609476910
Name:LINDEN, JACQUELINE LOUISE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LOUISE
Last Name:LINDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MILAN AVE LOT 186
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-8737
Mailing Address - Country:US
Mailing Address - Phone:419-366-3219
Mailing Address - Fax:
Practice Address - Street 1:520 MILAN AVE LOT 186
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-8737
Practice Address - Country:US
Practice Address - Phone:419-366-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH375079830995251E00000X, 3747P1801X, 376K00000X
253Z00000X, 376J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty