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NPI Code Detail

MEDICARE: MS. JENNIFER NICOLE OSEREDCZUK

MEDICARE: MS. JENNIFER NICOLE OSEREDCZUK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorC.1400057OH

General Provider Information

NPI Number : 1124473640
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER NICOLE OSEREDCZUK
Provider Business Mailing Address
First Line : 2301 SCRANTON RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-4311
Country : US
Telephone Number : 216-273-6998
Fax Number :
Provider Business Practice Location Address
First Line : 2301 SCRANTON RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-4311
Country : US
Telephone Number : 216-273-6998
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2016
Last Update Date : 05/03/2016

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