MEDICARE: JESSIKA C WALTON LPC

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
1	101YM0800X	Mental Health Counselor	C.2405714	OH

General Provider Information

NPI Number	:	1306550397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIKA C WALTON LPC

Provider Business Mailing Address
First Line	:	145 MILLER RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-2161
Country	:	US
Telephone Number	:	330-601-4619
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 CLEVELAND RD STE 200
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-1703
Country	:	US
Telephone Number	:	330-347-2925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2023
Last Update Date	:	06/12/2024

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