Provider Demographics
NPI:1801245493
Name:JAJACK, DOREEN NICOLE (LSW)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:NICOLE
Last Name:JAJACK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:DOREEN
Other - Middle Name:NICOLE
Other - Last Name:HIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6881 BEECHMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2907
Mailing Address - Country:US
Mailing Address - Phone:513-233-4758
Mailing Address - Fax:
Practice Address - Street 1:6881 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230
Practice Address - Country:US
Practice Address - Phone:513-233-4758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.16002681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical