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General NPI Number Information
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NPI Number | 1801610431
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Entity Type | Individual
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Provider Name | JESSICCA R KANECK
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Gender | Female
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 165 E PARK AVE
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City | NILES
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State | OH
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Zip | 44446-2352
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Country | US
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Telephone | 330-544-8005
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Fax | 330-544-9379
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Provider Business Mailing Address
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Address Line | 4151 LOGAN GATE RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44505-5706
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Country | US
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Telephone | 330-692-3981
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2511778
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License Number State | OH
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