Healthcare Provider Details

I. General information

NPI: 1548076920
Provider Name (Legal Business Name): BRIDGETT DANIELLE JOHNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CROSS ST
AKRON OH
44311-1026
US

IV. Provider business mailing address

150 CROSS ST
AKRON OH
44311-1026
US

V. Phone/Fax

Practice location:
  • Phone: 330-996-9141
  • Fax: 330-253-0377
Mailing address:
  • Phone: 330-996-9141
  • Fax: 330-253-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: