Healthcare Provider Details

I. General information

NPI: 1063323442
Provider Name (Legal Business Name): JESS LEELA WILLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 DODGE AVE
AKRON OH
44302-1243
US

IV. Provider business mailing address

158 DODGE AVE
AKRON OH
44302-1243
US

V. Phone/Fax

Practice location:
  • Phone: 216-760-3448
  • Fax:
Mailing address:
  • Phone: 216-760-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberNONE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: