Healthcare Provider Details

I. General information

NPI: 1437880911
Provider Name (Legal Business Name): MR. JARON JACKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 CENTRAL PARK W
TOLEDO OH
43617-3008
US

IV. Provider business mailing address

PO BOX 20068
TOLEDO OH
43610-0068
US

V. Phone/Fax

Practice location:
  • Phone: 888-442-2323
  • Fax:
Mailing address:
  • Phone: 419-531-5544
  • 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 Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1437880911
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: