Provider Demographics
NPI:1962581173
Name:BURKHOLDER, JESSICA RENO (PC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENO
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:D
Other - Last Name:RENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PC
Mailing Address - Street 1:87 N CANTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-3838
Mailing Address - Country:US
Mailing Address - Phone:330-794-4254
Mailing Address - Fax:330-794-4262
Practice Address - Street 1:312 LOCUST ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1801
Practice Address - Country:US
Practice Address - Phone:330-762-0591
Practice Address - Fax:330-762-2242
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0500766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional