Healthcare Provider Details

I. General information

NPI: 1639402829
Provider Name (Legal Business Name): MS. REBECCA NORDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 E 9TH ST
CLEVELAND OH
44199-2001
US

IV. Provider business mailing address

1240 E 9TH ST
CLEVELAND OH
44199-2001
US

V. Phone/Fax

Practice location:
  • Phone: 216-902-6398
  • Fax:
Mailing address:
  • Phone: 216-902-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0006564
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0487344
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: