Healthcare Provider Details

I. General information

NPI: 1871008987
Provider Name (Legal Business Name): JASON FOLEY LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7243 SAWMILL RD STE 105
DUBLIN OH
43016
US

IV. Provider business mailing address

7652 SAWMILL RD STE 311
DUBLIN OH
43016-9296
US

V. Phone/Fax

Practice location:
  • Phone: 614-634-2405
  • Fax: 614-389-3841
Mailing address:
  • Phone: 614-634-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: