Healthcare Provider Details

I. General information

NPI: 1962581173
Provider Name (Legal Business Name): JESSICA RENO BURKHOLDER PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA D RENO PC

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 LOCUST ST
AKRON OH
44302-1801
US

IV. Provider business mailing address

87 N CANTON RD
AKRON OH
44305-3838
US

V. Phone/Fax

Practice location:
  • Phone: 330-762-0591
  • Fax: 330-762-2242
Mailing address:
  • Phone: 330-794-4254
  • Fax: 330-794-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0500766
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: