Provider Demographics
NPI:1558154138
Name:BERRY, JALIA C
Entity type:Individual
Prefix:
First Name:JALIA
Middle Name:C
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 DELAVAN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1326
Mailing Address - Country:US
Mailing Address - Phone:614-615-3790
Mailing Address - Fax:
Practice Address - Street 1:2211 LAKE CLUB DR STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3204
Practice Address - Country:US
Practice Address - Phone:614-816-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator