Provider Demographics
NPI:1558984492
Name:LARRY, JASON M
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:LARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-932-6232
Practice Address - Street 1:212 W JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2731
Practice Address - Country:US
Practice Address - Phone:614-729-2024
Practice Address - Fax:614-729-2030
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator