Provider Demographics
NPI:1649773862
Name:HOSKINS, JASON A
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:HOSKINS
Suffix:
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 1:3575 FOREST LAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8115
Mailing Address - Country:US
Mailing Address - Phone:330-703-0105
Mailing Address - Fax:
Practice Address - Street 1:3575 FOREST LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8115
Practice Address - Country:US
Practice Address - Phone:330-703-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1800937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional