Provider Demographics
NPI:1104621861
Name:HARDY, JEFFREY ALAN
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:HARDY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W DAYTON YELLOW SPRINGS RD APT 122
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3289
Mailing Address - Country:US
Mailing Address - Phone:937-371-5980
Mailing Address - Fax:
Practice Address - Street 1:116 E NORTH COLLEGE ST
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1639
Practice Address - Country:US
Practice Address - Phone:937-913-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator