Healthcare Provider Details

I. General information

NPI: 1629526041
Provider Name (Legal Business Name): JARED LINK PSYD, ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND TX
78236-5638
US

IV. Provider business mailing address

500 E 3RD ST APT 605
DAYTON OH
45402-5109
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-7361
  • Fax:
Mailing address:
  • Phone: 937-257-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY60807813
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: