Individual
JERAD MINIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
195 UNION ST, NEWARK, OH 43055-3919
(740) 485-8005
Mailing address
796 MANCHESTER CT, PICKERINGTON, OH 43147-2079
(937) 441-0159
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
S.1903607
OH
1041C0700X
Clinical Social Worker
Primary
I.2304673
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0352324
—
OH
Enumeration date
06/04/2019
Last updated
08/07/2023
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