Healthcare Provider Details

I. General information

NPI: 1811810930
Provider Name (Legal Business Name): JESSICA KNITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 SOUTH ST SE
WARREN OH
44484-2447
US

IV. Provider business mailing address

8200 SOUTH ST SE
WARREN OH
44484-2447
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-8200
  • Fax:
Mailing address:
  • Phone: 330-856-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00628
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: