Jackie Ezell

NPI #1801201314 in Youngstown, Ohio

Provider Information

NPI Number: 1801201314
Entity Type: Organization
Organization Name: Jackie Ezell
Primary Specialty: Community Health Worker
Enumeration Date: Jun 23, 2014
Last Updated: Jun 23, 2014

Practice Location

Address: 516 GRIFFITH ST UNIT 401
City: Youngstown
State: Ohio
ZIP Code: 44510-2604
Phone: (330) 787-5754

Authorized Official

Name: JACKIE DENESE EZELL
Title: INDEPENDENT PROVIDER
Phone: 330787575431

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Health Worker	172V00000X	Primary

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