Basic Information
| Provider Information | |||||||||
| NPI: | 1225400864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GATES | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5399 LAUBY RD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | NORTH CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447201554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304977726 | ||||||||
| FaxNumber: | 3304977748 | ||||||||
| Practice Location | |||||||||
| Address1: | 5399 LAUBY RD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | NORTH CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447201554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304977726 | ||||||||
| FaxNumber: | 3304977748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2015 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S 1500263 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.