Individual
JASON RICHARD ELLSWORTH MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
2233 ROCKY LN, ASHLAND, OH 44805-4701
(419) 281-3716
(419) 281-4605
Mailing address
2233 ROCKY LN, ASHLAND, OH 44805-4701
(419) 281-3716
(419) 281-4605
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.0600769
OH
Other
Enumeration date
04/29/2011
Last updated
05/02/2011
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