Healthcare Provider Details

I. General information

NPI: 1023848058
Provider Name (Legal Business Name): JAYLEN TEREYLL HEWLETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 KNOLLWOOD AVE
YOUNGSTOWN OH
44514-1525
US

IV. Provider business mailing address

2359 KNOLLWOOD AVE
YOUNGSTOWN OH
44514-1525
US

V. Phone/Fax

Practice location:
  • Phone: 216-260-1405
  • Fax: 330-632-8823
Mailing address:
  • Phone: 216-260-1405
  • Fax: 800-632-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: