Provider Demographics
NPI:1548609985
Name:DUGAN, JENNIFER ROBERTS (LISW-S)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBERTS
Last Name:DUGAN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW-S
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-0324
Mailing Address - Country:US
Mailing Address - Phone:440-536-1004
Mailing Address - Fax:440-397-0351
Practice Address - Street 1:7506 TYLER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5450
Practice Address - Country:US
Practice Address - Phone:440-536-1004
Practice Address - Fax:800-397-0351
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI13025251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical