Individual
JERRY MERIDITH HEISTAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPRS
Contact information
Practice address
551 1/2 E MAIN ST, LANCASTER, OH 43130-3809
(614) 404-6008
Mailing address
PO BOX 243, SUGAR GROVE, OH 43155-0243
(614) 404-6008
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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