Provider Demographics
NPI:1528465218
Name:JAQUAY, CHINNON
Entity type:Individual
Prefix:
First Name:CHINNON
Middle Name:
Last Name:JAQUAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 W CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3452
Mailing Address - Country:US
Mailing Address - Phone:419-345-3471
Mailing Address - Fax:
Practice Address - Street 1:2740 W CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3452
Practice Address - Country:US
Practice Address - Phone:419-345-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1365211103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool