MEDICARE: MS. JENNIFER E PERROT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1366238503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER E PERROT

Provider Business Mailing Address
First Line	:	279 PHEASANT RUN RD SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-2355
Country	:	US
Telephone Number	:	330-598-5518
Fax Number	:

Provider Business Practice Location Address
First Line	:	279 PHEASANT RUN RD SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-2355
Country	:	US
Telephone Number	:	330-598-5518
Fax Number	:

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

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	03/17/2026

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