Healthcare Provider Details

I. General information

NPI: 1790613644
Provider Name (Legal Business Name): JADYN STARLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 OHIO PIKE STE 214
CINCINNATI OH
45255-3629
US

IV. Provider business mailing address

4145 S GENSEN LOOP
CINCINNATI OH
45245-7009
US

V. Phone/Fax

Practice location:
  • Phone: 513-655-6911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2607996
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: