Doctor Name: | KELSEY JAGER |
NPI Number: | 1457795726 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PC |
License Number: | C0900358 |
Business Practice Address: | 35888 Center Ridge Rd Suite 5 North Ridgeville, OH - 440396002 |
Business Phone Number: | 4403271800 |
Business Fax Number: | 4403271533 |
Mailing Address: | 35888 Center Ridge Rd, Suite 5 NORTH RIDGEVILLE |
State: | OH |
Postal Code: | 440396002 |
Phone Number: | 4403271800 |
Fax Number: | 4403271533 |
NPI Enumeration Date: | 04/17/2013 |
NPI Last Update Date: | 04/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | C0900358 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |