Healthcare Provider Details

I. General information

NPI: 1780486415
Provider Name (Legal Business Name): JENNIFER HULBOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 FAIRDALE DRIVE
CAMBRIDGE OH
43725
US

IV. Provider business mailing address

6105 FAIRDALE DR
CAMBRIDGE OH
43725
US

V. Phone/Fax

Practice location:
  • Phone: 740-232-9057
  • Fax:
Mailing address:
  • Phone: 740-232-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: