Healthcare Provider Details

I. General information

NPI: 1598520561
Provider Name (Legal Business Name): JEANIE ESTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 OFFICE PARK DR
DAYTON OH
45439-2298
US

IV. Provider business mailing address

1619 TEXAS CT
XENIA OH
45385-4864
US

V. Phone/Fax

Practice location:
  • Phone: 937-802-5440
  • Fax:
Mailing address:
  • Phone: 937-768-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number191058
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: