Provider Demographics
NPI:1538283445
Name:ECKERT, JANE LEHR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:LEHR
Last Name:ECKERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2694 HIGH HAMPTON TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3729
Mailing Address - Country:US
Mailing Address - Phone:330-923-4662
Mailing Address - Fax:330-923-4662
Practice Address - Street 1:3250 W MARKET ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3336
Practice Address - Country:US
Practice Address - Phone:330-835-9250
Practice Address - Fax:330-835-9255
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3179103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0547939Medicaid
OHCP08621Medicare ID - Type UnspecifiedPSYCHOLOGIST