Provider Demographics
NPI:1154130433
Name:PEELLE, JACQUELINE WHITNEY (CDCA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:WHITNEY
Last Name:PEELLE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TRIANGLE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3423
Mailing Address - Country:US
Mailing Address - Phone:740-895-0519
Mailing Address - Fax:866-542-4862
Practice Address - Street 1:1 TRIANGLE PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3423
Practice Address - Country:US
Practice Address - Phone:740-895-0519
Practice Address - Fax:866-542-4862
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190887101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty