Provider Demographics
NPI:1942848619
Name:DOODLEY, JACQUELINE T (OCPRS)
Entity Type:Individual
Prefix:PROF
First Name:JACQUELINE
Middle Name:T
Last Name:DOODLEY
Suffix:
Gender:F
Credentials:OCPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 PERDUE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1876
Mailing Address - Country:US
Mailing Address - Phone:614-440-2737
Mailing Address - Fax:
Practice Address - Street 1:2475 PERDUE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1876
Practice Address - Country:US
Practice Address - Phone:614-440-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01249175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist