Healthcare Provider Details

I. General information

NPI: 1538774153
Provider Name (Legal Business Name): SARAH LOUISE WOODSIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4478 S HILLS DR
CLEVELAND OH
44109-4479
US

IV. Provider business mailing address

4478 S HILLS DR
CLEVELAND OH
44109-4479
US

V. Phone/Fax

Practice location:
  • Phone: 216-315-3336
  • Fax:
Mailing address:
  • Phone: 216-414-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: