Healthcare Provider Details

I. General information

NPI: 1366948457
Provider Name (Legal Business Name): JODI HEDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 MAXWELL AVE
CINCINNATI OH
45219-2408
US

IV. Provider business mailing address

532 MAXWELL AVE
CINCINNATI OH
45219-2408
US

V. Phone/Fax

Practice location:
  • Phone: 513-559-2081
  • Fax: 513-559-2009
Mailing address:
  • Phone: 513-559-2081
  • Fax: 513-559-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: