Provider Demographics
NPI:1114809514
Name:HENLINE, JASON COLE
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:COLE
Last Name:HENLINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:COWEN
Mailing Address - State:WV
Mailing Address - Zip Code:26206-8635
Mailing Address - Country:US
Mailing Address - Phone:304-678-4817
Mailing Address - Fax:
Practice Address - Street 1:603 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1307
Practice Address - Country:US
Practice Address - Phone:304-602-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist