Healthcare Provider Details

I. General information

NPI: 1285930644
Provider Name (Legal Business Name): JENNIFER TOKER PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 EXCHANGE ST
CLEVELAND OH
44125-3345
US

IV. Provider business mailing address

20006 DETROIT RD SUITE 200
ROCKY RIVER OH
44116-2406
US

V. Phone/Fax

Practice location:
  • Phone: 216-332-9360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0003782
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: