Healthcare Provider Details

I. General information

NPI: 1568963379
Provider Name (Legal Business Name): JENNIFER L DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MARKET AVE N
CANTON OH
44702-1017
US

IV. Provider business mailing address

624 MARKET AVE N
CANTON OH
44702-1017
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-4553
  • Fax: 330-493-3761
Mailing address:
  • Phone: 330-493-4553
  • Fax: 330-493-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607426
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF2000141-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: