Provider Information for 1376093989
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JEFFERSON D COLLIER LPC
Sex: Male
NPI: 1376093989
Last Updated: 2025-04-10
Certification Date: 2025-04-10
Certification Date: 2025-04-10
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1376093989 | ||||||||||||
| Enumeration Date | 2016-10-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2500 JOHN GLENN HWY CAMBRIDGE, OH 43725-9028 United States Phone: 740-439-4428 | Fax:740-588-6452 | ||||||||||||
| Primary Practice Address | 2000 NOBLE DR WOOSTER, OH 44691-5353 United States Phone: 330-264-3232 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 2500 JOHN GLENN HWY | ||||||||||||
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