Provider Demographics
NPI:1639997653
Name:EBERHART, JESSICCA V
Entity type:Individual
Prefix:
First Name:JESSICCA
Middle Name:V
Last Name:EBERHART
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 1:818 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3864
Mailing Address - Country:US
Mailing Address - Phone:216-262-1369
Mailing Address - Fax:
Practice Address - Street 1:9225 LINCOLN DR APT F10
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1155
Practice Address - Country:US
Practice Address - Phone:216-466-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator