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General NPI Number Information
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NPI Number | 1942753405
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Entity Type | Individual
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Provider Name | JENNIFER GOGOLEK LPCC-S
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Gender | Female
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Dates
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Enumeration Date | 08/01/2016
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 970 E WASHINGTON ST
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City | MEDINA
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State | OH
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Zip | 44256-3332
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Country | US
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Telephone | 330-721-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 970 E WASHINGTON ST
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City | MEDINA
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State | OH
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Zip | 44256-3332
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Country | US
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Telephone | 330-721-5700
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E00008059
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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