Provider Demographics
NPI:1407626161
Name:PARKS, STEVEN JORDAN SR
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JORDAN
Last Name:PARKS
Suffix:SR
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 1:5650 W CENTRAL AVE STE D4
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1526
Mailing Address - Country:US
Mailing Address - Phone:419-517-1200
Mailing Address - Fax:
Practice Address - Street 1:5650 W CENTRAL AVE STE D4
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1526
Practice Address - Country:US
Practice Address - Phone:419-517-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator