Individual
JERRY RYAN HACKLEY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LSW
Contact information
Practice address
269 CENTER ST, SEVILLE, OH 44273-8864
(330) 591-4648
Mailing address
269 CENTER ST, SEVILLE, OH 44273-8864
(330) 591-4648
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.1903598
OH
Other
Enumeration date
09/20/2018
Last updated
05/22/2019
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