Healthcare Provider Details

I. General information

NPI: 1568909323
Provider Name (Legal Business Name): JERRA HUXFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date: 08/29/2017
Reactivation Date: 09/12/2018

III. Provider practice location address

5151 MAIN ST
SYLVANIA OH
43560-2184
US

IV. Provider business mailing address

5151 MAIN ST
SYLVANIA OH
43560-2184
US

V. Phone/Fax

Practice location:
  • Phone: 419-266-0072
  • Fax: 419-754-2306
Mailing address:
  • Phone: 419-266-0072
  • Fax: 419-754-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.1800068
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: