Individual
JACOB T THEADEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 MADISON RD, CINCINNATI, OH 45206
(513) 354-5200
(513) 354-7115
Mailing address
1501 MADISON RD, CINCINNATI, OH 45206
(513) 354-5200
(513) 354-7115
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.183225
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
LICENSURE BOARD
OH
Enumeration date
01/16/2023
Last updated
01/16/2023
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