Healthcare Provider Details

I. General information

NPI: 1003735671
Provider Name (Legal Business Name): ELIZABETH COLLYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29125 CHAGRIN BLVD
BEACHWOOD OH
44122-4609
US

IV. Provider business mailing address

2207 LARCHMONT DR
WICKLIFFE OH
44092-2437
US

V. Phone/Fax

Practice location:
  • Phone: 219-292-3999
  • Fax: 216-916-9147
Mailing address:
  • Phone: 219-292-3999
  • Fax: 216-916-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: