Healthcare Provider Details

I. General information

NPI: 1922254986
Provider Name (Legal Business Name): JESSICA ELAINE EMICK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14538 GRAPELAND AVE
CLEVELAND OH
44111-2107
US

IV. Provider business mailing address

14538 GRAPELAND AVE
CLEVELAND OH
44111-2107
US

V. Phone/Fax

Practice location:
  • Phone: 216-252-1399
  • Fax: 216-252-1409
Mailing address:
  • Phone: 216-252-1399
  • Fax: 216-252-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6467
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: