Healthcare Provider Details

I. General information

NPI: 1902739329
Provider Name (Legal Business Name): JARED MOODY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 DELAWARE AVE
MARION OH
43302-6475
US

IV. Provider business mailing address

1199 DELAWARE AVE
MARION OH
43302-6475
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-6835
  • Fax:
Mailing address:
  • Phone: 440-260-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: