Individual
JACLYN TISSUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-S, LCDCIII
Contact information
Practice address
6767 GENDER RD, CANAL WINCHESTER, OH 43110-9046
(614) 920-2747
Mailing address
6767 GENDER RD, CANAL WINCHESTER, OH 43110-9046
(614) 920-2747
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I 1000146
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08258
—
OH
Enumeration date
05/28/2011
Last updated
04/20/2026
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