Healthcare Provider Details

I. General information

NPI: 1962327940
Provider Name (Legal Business Name): HEIDI RAE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 LAURA AVE APT A
LANCASTER OH
43130-2092
US

IV. Provider business mailing address

2628 KULL RD
LANCASTER OH
43130-7707
US

V. Phone/Fax

Practice location:
  • Phone: 614-762-0729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAPP001049939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: