Provider Demographics
NPI:1346609427
Name:BANN, JESSICA (LPCC-S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BANN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1217
Mailing Address - Country:US
Mailing Address - Phone:440-234-2006
Mailing Address - Fax:440-260-8305
Practice Address - Street 1:3500 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2641
Practice Address - Country:US
Practice Address - Phone:440-260-8900
Practice Address - Fax:440-260-8576
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100476101YP2500X
OHE.1100476-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional