Provider Demographics
NPI:1881130821
Name:CASE, JACQUELINE M (BS, MA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:CASE
Suffix:
Gender:F
Credentials:BS, MA
Other - Prefix:
Other - First Name:JACQUI
Other - Middle Name:
Other - Last Name:NEITHAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MA
Mailing Address - Street 1:1035 ELCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1968
Mailing Address - Country:US
Mailing Address - Phone:262-893-7049
Mailing Address - Fax:
Practice Address - Street 1:1035 ELCLIFF DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1968
Practice Address - Country:US
Practice Address - Phone:262-893-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-15
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CO0020303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist