Provider Demographics
NPI:1568112886
Name:HARRAH, JESSICA LINN (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LINN
Last Name:HARRAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LINN
Other - Last Name:SKOGLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:10190 US HIGHWAY 42 STE 120
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9525
Mailing Address - Country:US
Mailing Address - Phone:614-792-5200
Mailing Address - Fax:614-792-5353
Practice Address - Street 1:10190 US HIGHWAY 42 STE 120
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9525
Practice Address - Country:US
Practice Address - Phone:614-792-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2025-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.016885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0484699Medicaid