Provider Demographics
NPI:1346577087
Name:JAXSON-JAGER, CAROL MARIE III (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:MARIE
Last Name:JAXSON-JAGER
Suffix:III
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 BELMONTE PARK N
Mailing Address - Street 2:SUITE A PO BOX 1113
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4749
Mailing Address - Country:US
Mailing Address - Phone:937-938-5642
Mailing Address - Fax:
Practice Address - Street 1:531 BELMONTE PARK N
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4749
Practice Address - Country:US
Practice Address - Phone:937-938-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900539.TEMP101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional