Healthcare Provider Details

I. General information

NPI: 1992637789
Provider Name (Legal Business Name): JORDAN DODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 EUCLID AVE
CLEVELAND OH
44115-2226
US

IV. Provider business mailing address

11583 MAPLERIDGE DR
NORTH ROYALTON OH
44133-2901
US

V. Phone/Fax

Practice location:
  • Phone: 216-687-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberLE-00065115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: