Individual
JENA M IACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC-S
Contact information
Practice address
6500 ROCKSIDE RD STE 385, INDEPENDENCE, OH 44131-2353
(216) 468-5000
Mailing address
8404 N BOYDEN RD, SAGAMORE HILLS, OH 44067-1718
(216) 816-7439
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
E.2102128
—
101YP2500X
Professional Counselor
C1801539
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659847077
—
OH
01
—
APP-00172576
LICENSE/ ENDORSEMENT NUMBER - COUNSELOR
OH
Enumeration date
10/24/2018
Last updated
03/11/2024
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