Provider Demographics
NPI:1568194785
Name:ACKER, JAYSA LB
Entity type:Individual
Prefix:
First Name:JAYSA
Middle Name:LB
Last Name:ACKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-0132
Mailing Address - Country:US
Mailing Address - Phone:800-321-8293
Mailing Address - Fax:
Practice Address - Street 1:1154 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1304
Practice Address - Country:US
Practice Address - Phone:800-321-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker