Healthcare Provider Details

I. General information

NPI: 1881526846
Provider Name (Legal Business Name): JASON JENKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MARKET ST
TROY OH
45373-1418
US

IV. Provider business mailing address

15275 WELLS RD
ANNA OH
45302-2500
US

V. Phone/Fax

Practice location:
  • Phone: 937-332-6700
  • Fax:
Mailing address:
  • Phone: 937-332-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: