MEDICARE: MS. REBECCA NORDIN

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	101YP2500X	Professional Counselor	0006564	CO
2	101YS0200X	School Counselor	0487344	CO

General Provider Information

NPI Number	:	1639402829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA NORDIN

Provider Business Mailing Address
First Line	:	1240 E 9TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44199-2001
Country	:	US
Telephone Number	:	216-902-6398
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 E 9TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44199-2001
Country	:	US
Telephone Number	:	216-902-6398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2009
Last Update Date	:	10/02/2014

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