Healthcare Provider Details

I. General information

NPI: 1346325552
Provider Name (Legal Business Name): KATHRYN C. MACCLUSKIE PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 COLUMBIA AVE
ELYRIA OH
44035-6001
US

IV. Provider business mailing address

145 COLUMBIA AVE
ELYRIA OH
44035-6001
US

V. Phone/Fax

Practice location:
  • Phone: 440-371-3423
  • Fax:
Mailing address:
  • Phone: 440-371-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: