Jack Stephens
Individual provider Active NPI School Psychologist · Riverside, OH
NPI 1700200680 · NPPES record last updated Feb 12, 2014
Key facts
- NPI
- 1700200680
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 1155279 (OH)
- Practice address
- 801 Old Harshman Rd
Riverside, OH 45431-1238 - Phone
- (937) 259-6603
- Fax
- (937) 259-6611
- NPI assigned
- Feb 12, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1155279 | OH | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mad River Local Schools | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1155279 | OH | Yes |
Addresses
Primary practice location
801 Old Harshman Rd
Riverside, OH 45431-1238
Mailing address
801 Old Harshman Rd
Riverside, OH 45431-1238
Other providers in Riverside, OH
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- Paul Rekers
- Andrew William Sheets
- Christine R Skujins
- Kara Suzanne Sraj
- Unity & Hope Home Care LLC
- Judith Uwase
- Mark A Ward
- Toya Jean Wiley-Gueye
- Angela C Williams
All providers in Riverside, OH · School Psychologist in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.