Healthcare Provider Details

I. General information

NPI: 1114233921
Provider Name (Legal Business Name): LAURA M HANCOCK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA HANCOCK BAKER PHD

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # S31
CLEVELAND OH
44195-5105
US

IV. Provider business mailing address

9600 EUCLID AVE # S31
CLEVELAND OH
44106
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-1637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3294
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08442
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP.08442
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: