Healthcare Provider Details

I. General information

NPI: 1487673810
Provider Name (Legal Business Name): DIANE STANLEY CLEMENTS M.S.,C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE NE5
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

20900 ALMAR DR
SHAKER HEIGHTS OH
44122-3811
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-0839
  • Fax: 216-445-6935
Mailing address:
  • Phone: 216-491-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: