Healthcare Provider Details

I. General information

NPI: 1366625154
Provider Name (Legal Business Name): RENEE DENISE BLACKMON PARAPROFESSIONAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 EAST 126TH STREET
CLEVELAND OH
44108
US

IV. Provider business mailing address

707 EAST 126TH STREET
CLEVELAND OH
44108
US

V. Phone/Fax

Practice location:
  • Phone: 216-240-7985
  • Fax: 216-761-8925
Mailing address:
  • Phone: 216-240-7985
  • Fax: 216-761-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number260608981019
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: