Provider Demographics
NPI:1891141198
Name:MESHELEMIAH, JACQUELYN CA (LSW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:CA
Last Name:MESHELEMIAH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 DUBLIN RD
Mailing Address - Street 2:STE 212C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1000
Mailing Address - Country:US
Mailing Address - Phone:614-437-9910
Mailing Address - Fax:
Practice Address - Street 1:1335 DUBLIN RD
Practice Address - Street 2:STE 212C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1000
Practice Address - Country:US
Practice Address - Phone:614-437-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.00211781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical