Healthcare Provider Details

I. General information

NPI: 1720991482
Provider Name (Legal Business Name): ANGELICA JNA REDITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WOODSTOCK AVE
TOLEDO OH
43607-3771
US

IV. Provider business mailing address

16 E STREICHER ST
TOLEDO OH
43608-1820
US

V. Phone/Fax

Practice location:
  • Phone: 419-536-9959
  • Fax:
Mailing address:
  • Phone: 419-609-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberTA336677
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: