Healthcare Provider Details

I. General information

NPI: 1831006279
Provider Name (Legal Business Name): JARED ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 MONROE ST STE F-G
TOLEDO OH
43606-1981
US

IV. Provider business mailing address

4333 MONROE ST STE F-G
TOLEDO OH
43606-1981
US

V. Phone/Fax

Practice location:
  • Phone: 419-724-4973
  • Fax:
Mailing address:
  • Phone: 419-724-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: