Healthcare Provider Details

I. General information

NPI: 1114785201
Provider Name (Legal Business Name): KATELYN TIMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATELYN MOREEN

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3094 W MARKET ST STE 105
FAIRLAWN OH
44333-3617
US

IV. Provider business mailing address

434 EASTLAND RD STE 305
BEREA OH
44017-1217
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-6835
  • Fax:
Mailing address:
  • Phone: 440-234-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS.2605337-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: