Provider Demographics
NPI:1700763497
Name:REASOR, JACQUELINE (PSYS)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:REASOR
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 DETROIT AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3922
Mailing Address - Country:US
Mailing Address - Phone:216-200-6396
Mailing Address - Fax:
Practice Address - Street 1:14900 DETROIT AVE STE 206
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3922
Practice Address - Country:US
Practice Address - Phone:216-200-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.00748103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool