Healthcare Provider Details

I. General information

NPI: 1376351874
Provider Name (Legal Business Name): MRS. SARAH JEAN MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

IV. Provider business mailing address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-3521
  • Fax: 513-246-2080
Mailing address:
  • Phone: 513-381-6672
  • Fax: 513-246-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.194872
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: