Provider Demographics
NPI:1578811055
Name:WALTERS, JODI MARIE (MSSA, LSW)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:MARIE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:MARIE
Other - Last Name:KOVACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6753 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4517
Mailing Address - Country:US
Mailing Address - Phone:216-319-0693
Mailing Address - Fax:440-843-1626
Practice Address - Street 1:6753 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4517
Practice Address - Country:US
Practice Address - Phone:216-319-0693
Practice Address - Fax:440-843-1626
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS09014501041C0700X
OHI.20023211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical