MEDICARE: JASON T BAILEY LISW

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	1041C0700X	Clinical Social Worker	I.2304991	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720444730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON T BAILEY LISW

Provider Business Mailing Address
First Line	:	PO BOX 933421
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0039
Country	:	US
Telephone Number	:	937-641-4000
Fax Number	:	937-641-4500

Provider Business Practice Location Address
First Line	:	1425 N FAIRFIELD RD STE 100
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2674
Country	:	US
Telephone Number	:	937-641-5772
Fax Number	:	937-641-4668

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

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	11/20/2025

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Directions to “ JASON T BAILEY LISW” Practice Location

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