Healthcare Provider Details

I. General information

NPI: 1487504544
Provider Name (Legal Business Name): MICHELLE CLEVELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 KARL RD
COLUMBUS OH
43229-5147
US

IV. Provider business mailing address

6037 CLEVELAND AVE
COLUMBUS OH
43231-2256
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-2588
  • Fax:
Mailing address:
  • Phone: 614-267-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2604843-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: