Healthcare Provider Details

I. General information

NPI: 1528396595
Provider Name (Legal Business Name): LAURA ELIZABETH ROUSH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH COTTRELL

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-707-6457
Mailing address:
  • Phone: 216-791-3800
  • Fax: 216-707-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6604
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: