Provider Demographics
NPI:1659581510
Name:JOHNSON, JENNIFER MCCLELLAN (MSSA,LISW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MCCLELLAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSSA,LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19420 LOMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5110
Mailing Address - Country:US
Mailing Address - Phone:216-295-1902
Mailing Address - Fax:
Practice Address - Street 1:100 PARKER CT
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1141
Practice Address - Country:US
Practice Address - Phone:440-286-1553
Practice Address - Fax:440-286-1318
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00057971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical