Provider Demographics
NPI:1700051620
Name:JACOTT, TERESA (LISW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:JACOTT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 ENTERPRISE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9436
Mailing Address - Country:US
Mailing Address - Phone:614-635-9011
Mailing Address - Fax:614-635-9014
Practice Address - Street 1:737 ENTERPRISE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9436
Practice Address - Country:US
Practice Address - Phone:614-635-9011
Practice Address - Fax:614-635-9014
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0017890104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty