Provider Demographics
NPI:1538806625
Name:JETT, JAYKEETA S (CDCA)
Entity type:Individual
Prefix:
First Name:JAYKEETA
Middle Name:S
Last Name:JETT
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COTTERREW DR APT 303
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9584
Mailing Address - Country:US
Mailing Address - Phone:614-549-1056
Mailing Address - Fax:
Practice Address - Street 1:6161 BUSCH BLVD STE 190
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2510
Practice Address - Country:US
Practice Address - Phone:866-285-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180740101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)