Basic Information
Provider Information
NPI: 1326375288
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OHM
FirstName: JODI
MiddleName: ANNE
NamePrefix: MRS.
NameSuffix:  
Credential: LPCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1925 HAYES AVE
Address2:  
City: SANDUSKY
State: OH
PostalCode: 448704737
CountryCode: US
TelephoneNumber: 4735575177
FaxNumber: 4195575179
Practice Location
Address1: 292 BENEDICT AVE
Address2:  
City: NORWALK
State: OH
PostalCode: 448572374
CountryCode: US
TelephoneNumber: 4196633737
FaxNumber: 4196635096
Other Information
ProviderEnumerationDate: 11/12/2009
LastUpdateDate: 07/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XE.1901295OHY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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