Healthcare Provider Details

I. General information

NPI: 1104740588
Provider Name (Legal Business Name): ISABEAU S. ROCKYMORE-BATEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

PO BOX 72767
CLEVELAND OH
44192-0004
US

IV. Provider business mailing address

41315 N RIDGE RD
ELYRIA OH
44035-1242
US

V. Phone/Fax

Practice location:
  • Phone: 800-860-7373
  • Fax:
Mailing address:
  • Phone: 440-366-1106
  • Fax: 440-366-7632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2308737
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: