Provider Demographics
NPI:1194968040
Name:PRATHER, JEFFREY WADE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WADE
Last Name:PRATHER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 COOPER RD
Mailing Address - Street 2:101A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7743
Mailing Address - Country:US
Mailing Address - Phone:513-489-1171
Mailing Address - Fax:513-489-6036
Practice Address - Street 1:7800 COOPER RD
Practice Address - Street 2:101A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7743
Practice Address - Country:US
Practice Address - Phone:513-489-1171
Practice Address - Fax:513-489-6036
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5659103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist