Healthcare Provider Details

I. General information

NPI: 1548087885
Provider Name (Legal Business Name): MR. PERRY JASON ESCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 GREENWOOD AVE
AKRON OH
44320-1865
US

IV. Provider business mailing address

596 GREENWOOD AVE
AKRON OH
44320-1865
US

V. Phone/Fax

Practice location:
  • Phone: 216-559-6074
  • Fax:
Mailing address:
  • Phone: 216-559-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.196459
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005570
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: