Healthcare Provider Details

I. General information

NPI: 1568009728
Provider Name (Legal Business Name): ESTEENA LENNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 MARKET AVE N
CANTON OH
44714-2340
US

IV. Provider business mailing address

1604 MARKET AVE N
CANTON OH
44714-2340
US

V. Phone/Fax

Practice location:
  • Phone: 234-207-3520
  • Fax:
Mailing address:
  • Phone: 234-207-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: