Healthcare Provider Details

I. General information

NPI: 1174912570
Provider Name (Legal Business Name): JENNY BJORK LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY KLUCARICH LPCC, NCC

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FRONT ST STE 215
CUYAHOGA FALLS OH
44221-3251
US

IV. Provider business mailing address

2101 FRONT ST STE 215
CUYAHOGA FALLS OH
44221-3251
US

V. Phone/Fax

Practice location:
  • Phone: 330-238-7286
  • Fax: 330-208-0931
Mailing address:
  • Phone: 330-238-7286
  • Fax: 330-208-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6328-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1901516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: