Provider Demographics
NPI:1164539946
Name:FREEMAN, JANE R (LISW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:R
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5822
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44372-5822
Mailing Address - Country:US
Mailing Address - Phone:330-962-6117
Mailing Address - Fax:
Practice Address - Street 1:575 WHITE POND DR
Practice Address - Street 2:SUITE B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1184
Practice Address - Country:US
Practice Address - Phone:330-962-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00008871041C0700X
OHE.0000092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH055386Medicare UPIN
OH53711Medicare UPIN
OH268415000Medicare UPIN
OH6270289Medicare UPIN
OHFRSW01371Medicare ID - Type UnspecifiedPRIVATE PRACTICE
ND000000113418Medicare UPIN
OH0005718214Medicare UPIN
R72641Medicare UPIN
OHFRSW75481Medicare ID - Type Unspecified