Provider Demographics
NPI:1306550397
Name:WALTON, JESSIKA C (LPC)
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:C
Last Name:WALTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2161
Mailing Address - Country:US
Mailing Address - Phone:330-601-4619
Mailing Address - Fax:
Practice Address - Street 1:2708 CLEVELAND RD STE 200
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1703
Practice Address - Country:US
Practice Address - Phone:330-347-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health