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General NPI Number Information
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NPI Number | 1154865087
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Entity Type | Individual
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Provider Name | JILL ADAMS
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Gender | Female
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 104 SPINK ST
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City | WOOSTER
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State | OH
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Zip | 44691-3652
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Country | US
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Telephone | 330-264-8498
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Fax |
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Provider Business Mailing Address
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Address Line | 625 CLEVELAND AVE NW
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City | CANTON
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State | OH
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Zip | 44702-1805
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Country | US
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Telephone | 330-453-8252
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Fax | 330-453-6716
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 001284
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License Number State | OH
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