Provider Demographics
NPI:1477383594
Name:KLOCKO, JASON ALLEN
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:KLOCKO
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 1:929 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1535
Mailing Address - Country:US
Mailing Address - Phone:419-261-1585
Mailing Address - Fax:
Practice Address - Street 1:929 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1535
Practice Address - Country:US
Practice Address - Phone:419-261-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker