Provider Demographics
NPI:1538432968
Name:LEDLOW, JONATHAN MARK (BSPSY, AACJ)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MARK
Last Name:LEDLOW
Suffix:
Gender:M
Credentials:BSPSY, AACJ
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Mailing Address - Street 1:8500 LINDBERGH BLVD
Mailing Address - Street 2:APT. #1814
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-1536
Mailing Address - Country:US
Mailing Address - Phone:215-921-6217
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:484-381-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)