Healthcare Provider Details

I. General information

NPI: 1790441350
Provider Name (Legal Business Name): JENNIFER LANNING PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S SAINT CLAIR ST
PAINESVILLE OH
44077-3421
US

IV. Provider business mailing address

134 S SAINT CLAIR ST
PAINESVILLE OH
44077-3421
US

V. Phone/Fax

Practice location:
  • Phone: 440-276-0514
  • Fax: 440-255-6348
Mailing address:
  • Phone: 440-276-0514
  • Fax: 440-255-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.185438
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1790441350
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0002450
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: