Provider Demographics
NPI:1417550906
Name:TEDRICK-MONROE, JAMIE LYNN (CDCA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:TEDRICK-MONROE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WOODHAVEN
Mailing Address - Street 2:1 ELIZABETH PLACE
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:46417
Mailing Address - Country:US
Mailing Address - Phone:937-783-2671
Mailing Address - Fax:937-783-2671
Practice Address - Street 1:WOODHAVEN
Practice Address - Street 2:1 ELIZABETH PLACE
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:46417
Practice Address - Country:US
Practice Address - Phone:937-783-2671
Practice Address - Fax:937-783-2671
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.167010101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)