Healthcare Provider Details

I. General information

NPI: 1114849635
Provider Name (Legal Business Name): JACOB MICHAEL LEPOIDEVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WADSWORTH RD
WADSWORTH OH
44281-9580
US

IV. Provider business mailing address

205 WADSWORTH RD
WADSWORTH OH
44281-9580
US

V. Phone/Fax

Practice location:
  • Phone: 234-217-8882
  • Fax: 234-217-8941
Mailing address:
  • Phone: 234-217-8882
  • Fax: 234-217-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: