Provider Demographics
NPI:1780451195
Name:JASINSKI, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:JASINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 US ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-9771
Mailing Address - Country:US
Mailing Address - Phone:937-503-5708
Mailing Address - Fax:
Practice Address - Street 1:1532 GLENBECK AVE APT 1
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1715
Practice Address - Country:US
Practice Address - Phone:937-999-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003772175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist