Individual
JACQUELYN N WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 GUILFORD BLVD, MEDINA, OH 44256-2135
(330) 590-7034
Mailing address
250 GUILFORD BLVD, MEDINA, OH 44256-2135
(330) 590-7034
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
133N00000X
Nutritionist
—
—
172A00000X
Driver
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
372600000X
Adult Companion
—
—
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
Primary
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
10/14/2024
Last updated
10/14/2024
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