Provider Demographics
NPI:1114738986
Name:CLOSE, JESSICA JOANNE (CPRS)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JOANNE
Last Name:CLOSE
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-1612
Mailing Address - Country:US
Mailing Address - Phone:440-261-2548
Mailing Address - Fax:
Practice Address - Street 1:1536 E 30TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-1612
Practice Address - Country:US
Practice Address - Phone:440-261-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005924171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach