Healthcare Provider Details

I. General information

NPI: 1780043554
Provider Name (Legal Business Name): JULIE ANNE JANCO- GIDLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANNE JANCO-GIDLEY PH.D.

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25101 CHAGRIN BLVD SUITE 200
BEACHWOOD OH
44122
US

IV. Provider business mailing address

25101 CHAGRIN BLVD SUITE 200
BEACHWOOD OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-273-8127
  • Fax: 440-260-8576
Mailing address:
  • Phone: 216-273-8127
  • Fax: 440-260-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6637
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6637
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: