Provider Demographics
NPI:1487275053
Name:NICHOLS, JODI LYNN
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2342
Mailing Address - Country:US
Mailing Address - Phone:330-304-8968
Mailing Address - Fax:
Practice Address - Street 1:807 E WASHINGTON ST STE 150
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3339
Practice Address - Country:US
Practice Address - Phone:330-241-4444
Practice Address - Fax:330-721-0013
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator