Provider Demographics
NPI:1407488604
Name:TUTTLE, JENNIFER DAWN (CDCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 COLEMAN CT
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-1207
Mailing Address - Country:US
Mailing Address - Phone:419-681-6100
Mailing Address - Fax:
Practice Address - Street 1:5414 HOMEGARDNER RD
Practice Address - Street 2:
Practice Address - City:CASTALIA
Practice Address - State:OH
Practice Address - Zip Code:44824-9420
Practice Address - Country:US
Practice Address - Phone:419-871-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)