Provider Demographics
NPI:1477362440
Name:IVORY, JAKIA ANN
Entity type:Individual
Prefix:
First Name:JAKIA
Middle Name:ANN
Last Name:IVORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 E WILBETH RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3535
Mailing Address - Country:US
Mailing Address - Phone:234-499-3136
Mailing Address - Fax:
Practice Address - Street 1:856 E WILBETH RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3535
Practice Address - Country:US
Practice Address - Phone:234-499-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities