Provider Demographics
NPI:1558171769
Name:JASTES, JACQUELINE (PEER SUPPRT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:JASTES
Suffix:
Gender:F
Credentials:PEER SUPPRT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:JASTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PEER SPECIALIST
Mailing Address - Street 1:1341 E 114TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1323
Mailing Address - Country:US
Mailing Address - Phone:216-906-1481
Mailing Address - Fax:
Practice Address - Street 1:1341 E 114TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1323
Practice Address - Country:US
Practice Address - Phone:216-906-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005836175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist