Provider Demographics
NPI:1013675081
Name:MCDONALD, JESSICA NOEL (LSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NOEL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 BARTISH DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2591
Mailing Address - Country:US
Mailing Address - Phone:440-452-9861
Mailing Address - Fax:
Practice Address - Street 1:130 SHADY LANE DR STE D
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2710
Practice Address - Country:US
Practice Address - Phone:567-743-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.19032901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical