Jacqulyn Smith | Willoughby, OH • PECOS Search

Jacqulyn Smith

Social Worker

Behavioral Health & Social Service Providers

36000 Euclid Ave, Willoughby, OH 44094-4625

PECOS Enrollment

Based on the most recent information from CMS, provider Jacqulyn Smith does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1619325917
Provider Type
Individual
Full Name
Smith, Jacqulyn
Credential
LSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
5/26/2016
Last Updated
5/26/2016

Contact Information

Practice Location

36000 Euclid Ave, Willoughby, OH 44094-4625

Unlisted Fax

Mailing Location

36000 Euclid Ave, Willoughby, OH 44094-4625

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License S 0017115 Ohio