Provider Demographics
NPI:1285975896
Name:WAUGH, JENNIFER ANN (PCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:WAUGH
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 KING ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2814
Mailing Address - Country:US
Mailing Address - Phone:330-235-4134
Mailing Address - Fax:
Practice Address - Street 1:226 KING ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2814
Practice Address - Country:US
Practice Address - Phone:330-235-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0900194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health