Active NPI
Jane R Bagnall, CDCA
- Addiction (Substance Use Disorder) Counselor
- Chardon, OH
National Provider Identifier
1366091092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CDCA181590
- Practice address
- 209 Center St
Chardon, OH 44024-1189 - Phone
- (440) 205-2670
- Fax
- (440) 285-8543
- NPI assigned
- Sep 5, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 0001422 | OH | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA181590 | OH | Primary |
Addresses
Primary practice location
209 Center St
Chardon, OH 44024-1189
Mailing address
209 Center St
Chardon, OH 44024-1189
Phone (440) 205-2670
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
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA181590 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| 0001422 | OH | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671408000000",
"number": "1366091092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 CENTER ST",
"city": "CHARDON",
"state": "OH",
"postal_code": "440241189",
"telephone_number": "440-205-2670",
"fax_number": "440-285-8543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 CENTER ST",
"city": "CHARDON",
"state": "OH",
"postal_code": "440241189",
"telephone_number": "440-205-2670",
"fax_number": "440-285-8543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGNALL",
"first_name": "JANE",
"middle_name": "R",
"name_prefix": "Mrs.",
"credential": "CDCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-05",
"last_updated": "2022-12-19",
"certification_date": "2022-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "0001422",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA181590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chardon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.