Healthcare Provider Details

I. General information

NPI: 1548156144
Provider Name (Legal Business Name): JADE LINDSEY DEERHAKE CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ELIDA RD STE 2
LIMA OH
45805-1232
US

IV. Provider business mailing address

3000 ELIDA RD STE 2
LIMA OH
45805-1232
US

V. Phone/Fax

Practice location:
  • Phone: 419-813-8009
  • Fax: 419-597-5051
Mailing address:
  • Phone: 419-813-8009
  • Fax: 419-597-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195732
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006377
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: