Healthcare Provider Details

I. General information

NPI: 1295211308
Provider Name (Legal Business Name): KATHY LEE LIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14538 GRAPELAND AVE
CLEVELAND OH
44111-2107
US

IV. Provider business mailing address

3352 STOCKHOLM RD
SHAKER HEIGHTS OH
44120-3458
US

V. Phone/Fax

Practice location:
  • Phone: 216-252-1399
  • Fax:
Mailing address:
  • Phone: 216-235-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08391
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: