Provider Demographics
NPI:1427539097
Name:FREEMAN, JOHN K (PEER SUPPORTER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PEER SUPPORTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1438
Mailing Address - Country:US
Mailing Address - Phone:330-379-3467
Mailing Address - Fax:330-379-3465
Practice Address - Street 1:665 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1438
Practice Address - Country:US
Practice Address - Phone:330-379-3467
Practice Address - Fax:330-379-3465
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847709Medicaid