Pettaway, Jala
Pettaway, Jala is an sole proprietor health care provider with primary practice located at 900 W South Boundary St , Perrysburg OH 43551-5230. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Other Service Providers / Case Manager/Care Coordinator. Other Service Providers / Case Manager/Care Coordinator is her primary health care specialty. Pettaway, Jala can be contacted via phone (419) 419-6211.Contact Information
Primary practice address
900 W South Boundary St
Perrysburg OH 43551-5230
Phone: (419) 419-6211
Fax: (419) 419-6231
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavior Technician | 106S00000X | ||
| Other Service Providers / Case Manager/Care Coordinator | 171M00000X |
Profile Details
| NPI number | 1174118921 |
|---|---|
| LBN Legal business name | Pettaway, Jala |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 3rd, 2021 |
| Last updated | Mar 28th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174118921 | NPPES |
| Ohio | MEDICAID | 2910854 |
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