Provider Demographics
NPI:1356002968
Name:STEVENSON, JEFFERY S (DMIN)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:S
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53420 EDEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45772-9010
Mailing Address - Country:US
Mailing Address - Phone:330-605-6311
Mailing Address - Fax:
Practice Address - Street 1:53420 EDEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45772-9010
Practice Address - Country:US
Practice Address - Phone:330-605-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist