Provider Demographics
NPI:1225400864
Name:GATES, JODI LYNN (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:GATES
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5399 LAUBY RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1554
Mailing Address - Country:US
Mailing Address - Phone:330-497-7726
Mailing Address - Fax:330-497-7748
Practice Address - Street 1:5399 LAUBY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1554
Practice Address - Country:US
Practice Address - Phone:330-497-7726
Practice Address - Fax:330-497-7748
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 1500263104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker