MEDICARE: JACQUELINE FRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023685815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE FRY

Provider Business Mailing Address
First Line	:	209 S MAIN ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44308-1307
Country	:	US
Telephone Number	:	216-302-8592
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 S MAIN ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44308-1307
Country	:	US
Telephone Number	:	216-302-8592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	03/13/2024

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Directions to “ JACQUELINE FRY ” Practice Location

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