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General NPI Number Information
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NPI Number | 1073201034
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Entity Type | Individual
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Provider Name | JORDAN FREDERICK
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 06/23/2024
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Provider Practice Location Address
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Address Line | 87 N CANTON RD
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City | AKRON
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State | OH
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Zip | 44305-3838
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Country | US
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Telephone | 330-794-4254
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Fax | 440-794-4262
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Provider Business Mailing Address
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Address Line | 1333 HOMESITE DR
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City | STOW
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State | OH
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Zip | 44224-1231
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Country | US
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Telephone | 440-539-3258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2405811
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License Number State | OH
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