Individual
JENNA WALTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
4641 FULTON DR NW, CANTON, OH 44718-2384
(330) 433-6075
Mailing address
4641 FULTON DR NW, CANTON, OH 44718-2384
(330) 433-6075
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0290822
—
OH
Enumeration date
07/16/2015
Last updated
07/16/2015
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