Provider Demographics
NPI:1053853499
Name:RAUSCH, JARED CONRAD
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:CONRAD
Last Name:RAUSCH
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 1:73 CYPRESS RUN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-5080
Mailing Address - Country:US
Mailing Address - Phone:843-505-5388
Mailing Address - Fax:
Practice Address - Street 1:1050 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5400
Practice Address - Country:US
Practice Address - Phone:843-524-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576000922Medicaid