Healthcare Provider Details

I. General information

NPI: 1295944403
Provider Name (Legal Business Name): JESSICA CYRAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE ML 3015
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVENUE ML 3015
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4336
  • Fax: 513-636-3677
Mailing address:
  • Phone: 513-636-4336
  • Fax: 513-636-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6473
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: