Healthcare Provider Details

I. General information

NPI: 1235691700
Provider Name (Legal Business Name): JON W FOUTS ACSW, LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 EAST FRONT ST STE 203
PATASKALA OH
43062-8357
US

IV. Provider business mailing address

590 NEWARK GRANVILLE RD
GRANVILLE OH
43023-1436
US

V. Phone/Fax

Practice location:
  • Phone: 740-877-8115
  • Fax:
Mailing address:
  • Phone: 888-531-7444
  • Fax: 614-867-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0008077
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: