Provider Demographics
NPI:1518939362
Name:JACKSON-WOHL, JENNIFER ANN (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:JACKSON-WOHL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:WOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 5TH ST NE
Mailing Address - Street 2:STE 4
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3017
Mailing Address - Country:US
Mailing Address - Phone:330-745-7263
Mailing Address - Fax:330-745-7806
Practice Address - Street 1:201 5TH ST NE
Practice Address - Street 2:STE 4
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3017
Practice Address - Country:US
Practice Address - Phone:330-745-7263
Practice Address - Fax:330-745-7806
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340081642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2601787Medicaid
OHI03220Medicare UPIN