Healthcare Provider Details

I. General information

NPI: 1972468460
Provider Name (Legal Business Name): JODY HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
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

5330 COLLOMORE RD
TOLEDO OH
43615-3516
US

V. Phone/Fax

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