Healthcare Provider Details

I. General information

NPI: 1912811407
Provider Name (Legal Business Name): JARRAD VAN STAN PHD, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 EUCLID AVE RM 203-C
CLEVELAND OH
44115-2215
US

IV. Provider business mailing address

1490 MARS AVE
LAKEWOOD OH
44107-3821
US

V. Phone/Fax

Practice location:
  • Phone: 216-687-3883
  • Fax:
Mailing address:
  • Phone: 216-687-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.17159
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: