Provider Demographics
NPI:1689162869
Name:HUNSICKER, JACQUELYN RAY
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:RAY
Last Name:HUNSICKER
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 1:775 E ELIZA ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1486
Mailing Address - Country:US
Mailing Address - Phone:419-679-1219
Mailing Address - Fax:
Practice Address - Street 1:775 E ELIZA ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326
Practice Address - Country:US
Practice Address - Phone:419-679-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator