NICOLE HERNDON (NPI# 1114569506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114569506 |
| Entity Type | Individual |
| Full Name | NICOLE HERNDON |
| Practice Address |
1114 Gonder Ave Se Canton OH 44707-3300 |
| Mailing Address |
5982 Rhodes Rd Kent OH 44240-8100 |
| Practice Telephone | 3304302801 |
| Mailing Telephone | 3306731347 |
| Mailing Fax Number | 3306783677 |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-10-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225493802 | Nicole Elizabeth Herndon | Speech-Language Pathologist | 11150 Fairfax Blvd, Suite 500, Fairfax, VA 22030-5066 | 2015-12-23 |
| Street Address |
1114 GONDER AVE SE |
| City | CANTON |
| State | OH |
| Zip Code | 44707-3300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649781717 | Linda Wilt | Licensed Practical Nurse | 620market Ave. S., Canton, OH 44707 | 2017-10-17 |
| 1558872622 | Michele Rose Strongoli-scott | Registered Nurse | 1620 Market Ave S., Canton, OH 44707 | 2017-10-17 |
| 1366972234 | Terri Sue Clendenin | Home Health Aide | 1317 Mattie St Sw, Canton, OH 44707 | 2017-06-14 |
| 1215467311 | Draya K Ellis | Community Health Worker | 408 9th Street Sw, Canton, OH 44707 | 2017-06-13 |
| 1720537780 | Individual | Preferred Provider Organization | 1111 Gonder Avenue Se, Canton, OH 44707 | 2016-09-30 |
| 1962958512 | Individual | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gonder Av Se, Canton, OH 44707 | 2016-09-01 |
| 1184070526 | Mj Harvey Development, LLC | Day Training, Developmentally Disabled Services | 804 Marion Ave Sw, Canton, OH 44707 | 2016-05-04 |
| 1164898516 | Erica Marie Brown | Occupational Therapy Assistant | 1620 Market Ave., South, Canton, OH 44707 | 2015-08-19 |
| 1508256439 | Kenny Mcclelland | Military/U.S. Coast Guard Transport | 903 Alan Page Dr Se # Apt1, Canton, OH 44707 | 2015-01-30 |
| 1295143550 | Susan Elaine Ball | Technician | 908 6th St Sw, Canton, OH 44707 | 2014-07-30 |
| Find all providers in zip 44707 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093350068 | Marc A Walker | Peer Specialist | 3311 12th St Nw, Canton, OH 44708-3909 | 2019-11-13 |
| 1588138390 | Angela Rhoad | Peer Specialist | Coleman Professional Services 400 Tuscarawas St W., Canton, OH 44702 | 2019-01-15 |
| 1851864144 | Jennifer Kathleen Shannon | Peer Specialist | 2945 Willowrow Ave Ne, Canton, OH 44705-3612 | 2019-01-09 |
| 1861962599 | Darnella L Jenkins | Peer Specialist | 2306 Crown Pl Nw, Canton, OH 44708-4420 | 2018-11-26 |
| 1396229027 | Michelle Lois Stackhouse | Peer Specialist | 5736 East Blvd Nw, Canton, OH 44718-1655 | 2018-09-19 |
| 1922520865 | Marc Slotnick | Peer Specialist | 43825 Michigan Ave., Canton, MI 48188 | 2017-07-12 |
| 1427656354 | Aaron Schreffler | Peer Specialist | 401 Tuscarawas St W Ste 501, Canton, OH 44702-2045 | 2020-10-13 |
| 1659985158 | Tracy Hart | Peer Specialist | 80 State Highway 310 Ste 1, Canton, NY 13617-1493 | 2020-09-02 |
| 1790309581 | Jamaine Thomas Atkins Sr. | Peer Specialist | 50430 School House Rd, Canton, MI 48187-5910 | 2020-06-08 |
| 1093338154 | Elvis Mcgrath | Peer Specialist | 1920 Schneider St Ne, Canton, OH 44721-3352 | 2020-05-24 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.