Healthcare Provider Details

I. General information

NPI: 1285568774
Provider Name (Legal Business Name): JAIDEN ALLOY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 N DETROIT ST
XENIA OH
45385-1960
US

IV. Provider business mailing address

5400 MONTGOMERY SQUARE DR APT M
DAYTON OH
45440-2925
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone: 937-403-7661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512712
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: