Provider Demographics
NPI:1134499395
Name:DAVIS, JENNIFER ADRIENNE (MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ADRIENNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ADRIENNE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PHD
Mailing Address - Street 1:105 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:KIPTON
Mailing Address - State:OH
Mailing Address - Zip Code:44049
Mailing Address - Country:US
Mailing Address - Phone:440-406-4918
Mailing Address - Fax:
Practice Address - Street 1:457 GRISWOLD RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2304
Practice Address - Country:US
Practice Address - Phone:440-406-4918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0460574Medicaid