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NPI Code Detail

MEDICARE: MS. JESSICA ANN REILLY MSSA, LISW, LICDC

MEDICARE: MS. JESSICA ANN REILLY MSSA, LISW, LICDC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162232OH
21041C0700XClinical Social WorkerI.2304446OH

General Provider Information

NPI Number : 1942726625
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA ANN REILLY MSSA, LISW, LICDC
Provider Business Mailing Address
First Line : 49 E GLENWOOD AVE
Second Line :
City : AKRON
State : OH
Zip : 44304-1137
Country : US
Telephone Number : 330-996-2222
Fax Number :
Provider Business Practice Location Address
First Line : 1804 E 55TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-3602
Country : US
Telephone Number : 216-762-1237
Fax Number : 212-321-7920
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2017
Last Update Date : 04/27/2023

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