Provider Demographics
NPI:1083959985
Name:BEALE, JENNIFER A (BSN, CRRN, CCM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:BEALE
Suffix:
Gender:F
Credentials:BSN, CRRN, CCM
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1530 LILLIAN RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2535
Mailing Address - Country:US
Mailing Address - Phone:330-256-0567
Mailing Address - Fax:330-688-4024
Practice Address - Street 1:1530 LILLIAN RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2535
Practice Address - Country:US
Practice Address - Phone:330-256-0567
Practice Address - Fax:330-688-4024
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170457171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator