Provider Demographics
NPI:1083929715
Name:FOSNAUGH, JESSICA (LPCC-S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FOSNAUGH
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FOSNAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22540 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2212
Mailing Address - Country:US
Mailing Address - Phone:440-734-4037
Mailing Address - Fax:
Practice Address - Street 1:22540 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2212
Practice Address - Country:US
Practice Address - Phone:440-734-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional