Provider Demographics
NPI:1760447130
Name:SALMONS, JILLIAN NICOLE (LISW)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:NICOLE
Last Name:SALMONS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:JILLIAN
Other - Middle Name:NICOLE
Other - Last Name:EYNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3086 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8409
Mailing Address - Country:US
Mailing Address - Phone:740-446-5500
Mailing Address - Fax:740-441-4402
Practice Address - Street 1:1 ACY AVE
Practice Address - Street 2:STE B
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-0828
Practice Address - Country:US
Practice Address - Phone:740-286-5075
Practice Address - Fax:740-288-7335
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI06001251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0253701Medicaid
OH0253701Medicaid
OHSASW32361Medicare PIN
OHSASW32363Medicare PIN