Healthcare Provider Details

I. General information

NPI: 1285135194
Provider Name (Legal Business Name): JORDAN ELIZABETH BREEDLOVE LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 HIWOOD AVE
MUNROE FALLS OH
44262-1246
US

IV. Provider business mailing address

337 HIWOOD AVE
MUNROE FALLS OH
44262-1246
US

V. Phone/Fax

Practice location:
  • Phone: 330-697-9273
  • Fax: 234-678-4970
Mailing address:
  • Phone: 330-697-9273
  • Fax: 234-678-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2102325
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: