Provider Demographics
NPI:1114555174
Name:WRIGHT, JEFFREY BRYAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRYAN
Last Name:WRIGHT
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 1:2174 METER RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-9480
Mailing Address - Country:US
Mailing Address - Phone:440-665-5825
Mailing Address - Fax:
Practice Address - Street 1:9451 E HARBOR RD
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:OH
Practice Address - Zip Code:43440-1310
Practice Address - Country:US
Practice Address - Phone:419-210-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician