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NPI Code Detail

MEDICARE: MRS. JENNIFER ANDREA PORTER PCC

MEDICARE:  MRS. JENNIFER ANDREA PORTER  PCC
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
1101YP2500XProfessional CounselorE.0500048OH

General Provider Information

NPI Number : 1659569317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER ANDREA PORTER PCC
Provider Business Mailing Address
First Line : 2803 AKRON RD
Second Line :
City : WOOSTER
State : OH
Zip : 44691-7904
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4440 POTH RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-1324
Country : US
Telephone Number : 614-751-9068
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2007
Last Update Date : 10/09/2007

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Directions to “ MRS. JENNIFER ANDREA PORTER PCC” Practice Location

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