Basic Information
| Provider Information | |||||||||
| NPI: | 1780893453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7901 DETROIT AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441022845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2166347500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7901 DETROIT AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441022845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2166347500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 07/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 101YP2500X | E0700197 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.