MEDICARE: JAKE POWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	APS.005582	OH

General Provider Information

NPI Number	:	1568282150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKE POWELL

Provider Business Mailing Address
First Line	:	1081 COUNTRY CLUB RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 COUNTRY CLUB RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1481
Country	:	US
Telephone Number	:	610-944-4082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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Directions to “ JAKE POWELL ” Practice Location

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