Provider Demographics
NPI:1144775081
Name:MESKO-KIMMICH, JENNIFER J (LPCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:MESKO-KIMMICH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 GAYLORD DR
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1113
Mailing Address - Country:US
Mailing Address - Phone:330-554-7165
Mailing Address - Fax:
Practice Address - Street 1:77 MILFORD DR STE 218
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2779
Practice Address - Country:US
Practice Address - Phone:330-650-4423
Practice Address - Fax:330-655-4329
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901212101YM0800X
OHC.0600167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health