Provider Demographics
NPI:1457376857
Name:MILLIKEN SABOL, JEAN E (LISW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:E
Last Name:MILLIKEN SABOL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:E
Other - Last Name:MILLIKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:230 SOUTH COURT ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-723-7977
Mailing Address - Fax:330-725-5177
Practice Address - Street 1:11565 PEARL ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-846-0862
Practice Address - Fax:440-846-0890
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05383311041C0700X
OHI0600123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker