Healthcare Provider Details

I. General information

NPI: 1164539946
Provider Name (Legal Business Name): JANE R FREEMAN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 WHITE POND DR SUITE B
AKRON OH
44320-1184
US

IV. Provider business mailing address

PO BOX 5822
AKRON OH
44372-5822
US

V. Phone/Fax

Practice location:
  • Phone: 330-962-6117
  • Fax:
Mailing address:
  • Phone: 330-962-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0000092
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0000887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: