Provider Demographics
NPI:1205024957
Name:SKRUCK, JENNIFER A (PCC-S)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:SKRUCK
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCC-S
Mailing Address - Street 1:365 RIFFEL RD STE B
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8592
Mailing Address - Country:US
Mailing Address - Phone:330-345-3461
Mailing Address - Fax:330-345-3462
Practice Address - Street 1:365 RIFFEL RD STE B
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-8592
Practice Address - Country:US
Practice Address - Phone:330-345-3461
Practice Address - Fax:330-345-3462
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008479-S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional