MEDICARE: CLEVELAND STATE UNIVERSITY SPEECH AND HEARING CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407077449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND STATE UNIVERSITY SPEECH AND HEARING CLINIC

Provider Business Mailing Address
First Line	:	2121 EUCLID AVE # MC-429
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2214
Country	:	US
Telephone Number	:	216-687-3804
Fax Number	:	216-687-6993

Provider Business Practice Location Address
First Line	:	2121 EUCLID AVE # MC-429
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2214
Country	:	US
Telephone Number	:	216-687-3804
Fax Number	:	216-687-6993

Authorized Official
Title or Position	:	CHAIRPERSON, HEALTH SCIENCES DEPT.
Name	:	MR. JOHN BAZYK
Credential	:	M.S.
Telephone Number	:	216-687-2379

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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Directions to “CLEVELAND STATE UNIVERSITY SPEECH AND HEARING CLINIC ” Practice Location

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