Provider Demographics
NPI:1447962964
Name:CORIELL, JESSICA DAWN (LISW-S)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:CORIELL
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 CORIELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-9085
Mailing Address - Country:US
Mailing Address - Phone:740-981-7759
Mailing Address - Fax:
Practice Address - Street 1:1131 CORIELL RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-9085
Practice Address - Country:US
Practice Address - Phone:740-981-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10003311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical