Healthcare Provider Details

I. General information

NPI: 1124840657
Provider Name (Legal Business Name): JEFF DAWSON CDCA PRELIMINARY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 WASSERMAN WAY
BATAVIA OH
45103-1974
US

IV. Provider business mailing address

1088 WASSERMAN WAY
BATAVIA OH
45103-1974
US

V. Phone/Fax

Practice location:
  • Phone: 513-735-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.189559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: