| Hope419, LLC | |
|
2267 Village Mall Dr Unit 2 Ontario OH 44906-1369 | |
| (419) 951-2020 | |
| Not Available |
| Full Name | Hope419, LLC |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2267 Village Mall Dr Unit 2, Ontario, Ohio |
| Authorized Official Name and Position | Johanna S. Wilson (CEO) |
| Authorized Official Contact | 3303283291 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hope419, LLC 2267 Village Mall Dr Unit 2 Ontario OH 44906-1369 Ph: (419) 951-2020 | Hope419, LLC 2267 Village Mall Dr Unit 2 Ontario OH 44906-1369 Ph: (419) 951-2020 |
| NPI Number | 1750990438 |
|---|---|
| Provider Enumeration Date | 07/28/2020 |
| Last Update Date | 09/15/2025 |
| Certification Date | 09/15/2025 |
| Medicare PECOS PAC ID | 8022506930 |
|---|---|
| Medicare Enrollment ID | O20251022004399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750990438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | () | Primary |
| 251S00000X | Community/behavioral Health | () | Secondary |
| Provider Name | Michaela R Stoll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831876283 PECOS PAC ID: 2769846070 Enrollment ID: I20230919002953 |
| Provider Name | Seth Burriss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417750779 PECOS PAC ID: 3577054063 Enrollment ID: I20251112003079 |
| Provider Name | Kerry Jeric |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538621792 PECOS PAC ID: 6305338906 Enrollment ID: I20251121000933 |
| Provider Name | Katie M Kissel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821546953 PECOS PAC ID: 3173959947 Enrollment ID: I20260115002706 |
| Provider Name | Hailey Schnellinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841951035 PECOS PAC ID: 7911485594 Enrollment ID: I20260204001265 |
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