Provider Demographics
NPI:1306920681
Name:FLETCHER, JANE MARIE (LISW-S)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARIE
Last Name:FLETCHER
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 1:715 S TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3237
Mailing Address - Country:US
Mailing Address - Phone:419-334-6619
Mailing Address - Fax:419-334-6663
Practice Address - Street 1:1100 E MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6381
Practice Address - Country:US
Practice Address - Phone:419-424-1471
Practice Address - Fax:419-424-1413
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00055771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100801Medicaid