Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 102L00000X | Psychologist | P.07917 | OH |
Y | 103T00000X | Psychologist | P.07917 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | P.07917 | OH |
NPI | 1144628751 |
---|---|
Provider Name | Jennifer Giesel |
First Address | Beachwood, OH 44122-5643 |
Second Address | Willoughby, OH 44094-9258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2014 |
Last Update Date | 06/02/2020 |