Healthcare Provider Details

I. General information

NPI: 1790027324
Provider Name (Legal Business Name): ALAN J HEJDUK LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 EUCLID AVE
CLEVELAND OH
44106-4310
US

IV. Provider business mailing address

12201 EUCLID AVE
CLEVELAND OH
44106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 216-707-3406
  • Fax: 216-707-3529
Mailing address:
  • Phone: 216-707-3406
  • Fax: 216-707-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0800253 SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: