Individual
JAIMEE LEIGH ELLERBROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2624 LEXINGTON AVE, SPRINGFIELD, OH 45505-2620
(937) 328-5300
(937) 322-4900
Mailing address
2624 LEXINGTON AVE, SPRINGFIELD, OH 45505-2620
(937) 328-5300
(937) 322-4900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.181883
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.162695
OH
171M00000X
Case Manager/Care Coordinator
CDCA.181883
OH
Other
Enumeration date
07/05/2022
Last updated
05/28/2024
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