Healthcare Provider Details

I. General information

NPI: 1093626871
Provider Name (Legal Business Name): TELECIA HANNAH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 EUCLID AVE
EUCLID OH
44117-1521
US

IV. Provider business mailing address

1716 OCTAVIA RD
CLEVELAND OH
44112-1411
US

V. Phone/Fax

Practice location:
  • Phone: 855-967-2436
  • Fax:
Mailing address:
  • Phone: 216-776-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number193394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: