=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093694036
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODI LEE WEBER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32730 WALKER RD STE J2
-----------------------------------------------------
City | AVON LAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44012-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-990-8822
-----------------------------------------------------
Fax | 513-992-9101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 248 MAIN ST APT 409
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-8166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-242-6561
-----------------------------------------------------
Fax | 513-992-9101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 107658
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I.2507157
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------