Provider Demographics
NPI:1396509329
Name:BURGER, JADE MARIE (CDCA)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:MARIE
Last Name:BURGER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:MARIE
Other - Last Name:BURGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDCAP
Mailing Address - Street 1:4600 MONTGOMERY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 S WOOSTER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1944
Practice Address - Country:US
Practice Address - Phone:833-510-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.184814101YA0400X
172V00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker