Provider Demographics
NPI:1912208372
Name:MCDOUGLE, JACQUELYN KAY
Entity Type:Individual
Prefix:MISS
First Name:JACQUELYN
Middle Name:KAY
Last Name:MCDOUGLE
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 1:5982 RHODES RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240
Mailing Address - Country:US
Mailing Address - Phone:330-673-1347
Mailing Address - Fax:330-678-3677
Practice Address - Street 1:400 W TUSCARAWAS ST SUITE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-3838
Practice Address - Country:US
Practice Address - Phone:330-438-2400
Practice Address - Fax:330-438-3003
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator