Healthcare Provider Details

I. General information

NPI: 1932819380
Provider Name (Legal Business Name): ZACHARY A JEDDING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MADISON RD
CINCINNATI OH
45206
US

IV. Provider business mailing address

1501 MADISON RD
CINCINNATI OH
45206
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-5200
  • Fax: 513-354-7115
Mailing address:
  • Phone: 513-354-5200
  • Fax: 513-354-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2608619
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII163008
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: