Healthcare Provider Details

I. General information

NPI: 1225616048
Provider Name (Legal Business Name): JADE ALEXIA ANTHONY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7593 TYLERS PLACE BLVD
WEST CHESTER OH
45069-6308
US

IV. Provider business mailing address

7593 TYLERS PLACE BLVD
WEST CHESTER OH
45069-6308
US

V. Phone/Fax

Practice location:
  • Phone: 513-644-2277
  • Fax:
Mailing address:
  • Phone: 513-644-2277
  • Fax: 513-644-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.175483
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: