Healthcare Provider Details

I. General information

NPI: 1710190020
Provider Name (Legal Business Name): PALEAH L HAIRSTON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 E LOCUST ST
LANCASTER OH
43130-4437
US

IV. Provider business mailing address

4861 FOUNDERS DR
GROVEPORT OH
43125-8934
US

V. Phone/Fax

Practice location:
  • Phone: 740-672-3855
  • Fax:
Mailing address:
  • Phone: 717-576-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2504160-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: