Provider Demographics
NPI:1861043895
Name:RIES, JARED ROBERT
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:ROBERT
Last Name:RIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JARED
Other - Middle Name:ROBERT
Other - Last Name:HENDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22001 FAIRMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6140 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3891
Practice Address - Country:US
Practice Address - Phone:440-233-7232
Practice Address - Fax:440-204-4315
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator