Healthcare Provider Details

I. General information

NPI: 1497842355
Provider Name (Legal Business Name): JANICE MCQUADE PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S DUMBLE RD SUITE A2
MANSFIELD OH
44907
US

IV. Provider business mailing address

259 SANDUCKY ST
ASHLAND OH
44805
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-0803
  • Fax: 419-756-0823
Mailing address:
  • Phone: 419-289-1876
  • Fax: 419-281-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8171
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: