Provider Demographics
NPI:1942857842
Name:GROH, JACLYN D (MSW)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:D
Last Name:GROH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 HILMAR DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9580
Mailing Address - Country:US
Mailing Address - Phone:810-923-8454
Mailing Address - Fax:
Practice Address - Street 1:635 PARK MEADOW RD STE 101
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2877
Practice Address - Country:US
Practice Address - Phone:810-923-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-25
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1600103-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical