Provider Demographics
NPI:1306617873
Name:SPAULDING-SCHECTER, JACOB S
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:S
Last Name:SPAULDING-SCHECTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8314 BRECKENRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1149
Mailing Address - Country:US
Mailing Address - Phone:614-787-1618
Mailing Address - Fax:
Practice Address - Street 1:77 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4960
Practice Address - Country:US
Practice Address - Phone:740-963-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036779363LP0808X
OHRN.519513163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse