Individual provider Active NPI

Jordyn Sedaker

  • Marriage & Family Therapist
  • Canton, OH
National Provider Identifier
1336738426
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
M2100193 Issued in OH
Practice address
624 Market Ave N
Canton, OH 44702-1017
Phone
(330) 493-4553
Fax
(330) 493-3761
NPI assigned
Jan 13, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X M2100193 OH Primary
CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101Y00000X M2000194 OH
Case Manager/Care CoordinatorGroup: 193400000X SINGLE SPECIALTY GROUP 171M00000X

Addresses

Primary practice location

624 Market Ave N
Canton, OH 44702-1017

Mailing address

624 Market Ave N
Canton, OH 44702-1017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
M2000194OHMDCounselor
M2100193OHMDMarriage & Family Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1336738426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021017",
            "telephone_number": "330-493-4553",
            "fax_number": "330-493-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEDAKER",
        "first_name": "JORDYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-13",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OH",
            "license": "M2100193",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "OH",
            "license": "M2000194",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.