Provider Demographics
NPI:1548156144
Name:DEERHAKE, JADE LINDSEY (CPRS)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:LINDSEY
Last Name:DEERHAKE
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ELIDA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1232
Mailing Address - Country:US
Mailing Address - Phone:419-813-8009
Mailing Address - Fax:419-597-5051
Practice Address - Street 1:3000 ELIDA RD STE 2
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1232
Practice Address - Country:US
Practice Address - Phone:419-813-8009
Practice Address - Fax:419-597-5051
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006377175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist