Healthcare Provider Details

I. General information

NPI: 1891682076
Provider Name (Legal Business Name): MISS JESSICA ANN MARTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 YOUNGSTOWN RD SE
WARREN OH
44484-5002
US

IV. Provider business mailing address

2737 YOUNGSTOWN RD SE
WARREN OH
44484-5002
US

V. Phone/Fax

Practice location:
  • Phone: 330-369-8022
  • Fax:
Mailing address:
  • Phone: 330-369-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.194967
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006758
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: