Healthcare Provider Details

I. General information

NPI: 1881198612
Provider Name (Legal Business Name): JACOB SAUER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WAYNE AVE
DAYTON OH
45410
US

IV. Provider business mailing address

9246 WESTBROOK RD
BROOKVILLE OH
45309-8307
US

V. Phone/Fax

Practice location:
  • Phone: 937-369-3094
  • Fax:
Mailing address:
  • Phone: 513-319-2179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.165160
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberW.1700073
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: