Healthcare Provider Details

I. General information

NPI: 1275944712
Provider Name (Legal Business Name): JACQUELIN ANN FIELDS LICDC LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E 89TH ST
CLEVELAND OH
44106-2007
US

IV. Provider business mailing address

27030 CEDAR RD APT.507, BUILDING 2
CLEVELAND OH
44122-1195
US

V. Phone/Fax

Practice location:
  • Phone: 216-231-3772
  • Fax: 216-231-5040
Mailing address:
  • Phone: 216-342-4222
  • Fax: 216-231-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number852174
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: