Provider Demographics
NPI:1801534706
Name:STROH, JAX BRITNEY
Entity type:Individual
Prefix:
First Name:JAX
Middle Name:BRITNEY
Last Name:STROH
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 1:525 MAYER RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:MI
Mailing Address - Zip Code:48027-3900
Mailing Address - Country:US
Mailing Address - Phone:810-936-1534
Mailing Address - Fax:
Practice Address - Street 1:3245 KEEWAHDIN RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3498
Practice Address - Country:US
Practice Address - Phone:810-937-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty