Provider Demographics
NPI:1275381741
Name:MCPHERSON, JENNIFER MARIA (CDCA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIA
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 W GRACE ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3221
Mailing Address - Country:US
Mailing Address - Phone:216-534-6252
Mailing Address - Fax:
Practice Address - Street 1:97 W GRACE ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3221
Practice Address - Country:US
Practice Address - Phone:216-534-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH188251101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)