Basic Information
| Provider Information | |||||||||
| NPI: | 1952774903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOOGAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1946 N 13TH ST | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436047258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197209247 | ||||||||
| FaxNumber: | 4197200304 | ||||||||
| Practice Location | |||||||||
| Address1: | 1832 ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436044428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197209247 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2015 | ||||||||
| LastUpdateDate: | 01/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C.1400588 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.