Healthcare Provider Details

I. General information

NPI: 1619468915
Provider Name (Legal Business Name): ALEXANDRA JEAN SCHENCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E MARKET ST
AKRON OH
44305-2422
US

IV. Provider business mailing address

1841 ASHTON LN APT 63
KENT OH
44240-8140
US

V. Phone/Fax

Practice location:
  • Phone: 330-315-3729
  • Fax:
Mailing address:
  • Phone: 814-321-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1901693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: