Healthcare Provider Details

I. General information

NPI: 1619605979
Provider Name (Legal Business Name): AARON I JEWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 BROADWAY AVE # 3932
CLEVELAND OH
44105-3932
US

IV. Provider business mailing address

11720 EDGEWATER DR APT 210
LAKEWOOD OH
44107-1769
US

V. Phone/Fax

Practice location:
  • Phone: 216-441-0200
  • Fax:
Mailing address:
  • Phone: 216-218-6807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: