Provider Demographics
NPI:1750819603
Name:BROOKS, JESSICA NICOLE (LISW-S)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:BROOKS
Suffix:
Gender:
Credentials:LISW-S
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18101 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5612
Mailing Address - Country:US
Mailing Address - Phone:216-476-7000
Mailing Address - Fax:216-442-5975
Practice Address - Street 1:18101 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-7000
Practice Address - Fax:216-442-5975
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23043261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical