Healthcare Provider Details

I. General information

NPI: 1336303692
Provider Name (Legal Business Name): MRS. SUSAN L JAROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 09/29/2026
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6614 SOUTHERN BLVD
BOARDMAN OH
44512-3455
US

IV. Provider business mailing address

6614 SOUTHERN BLVD
BOARDMAN OH
44512-3455
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-8855
  • Fax: 330-726-9182
Mailing address:
  • Phone: 330-726-8855
  • Fax: 330-726-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA00883
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA00883
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: