Healthcare Provider Details

I. General information

NPI: 1912625088
Provider Name (Legal Business Name): JASMINE KOCHHEISER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 TURNEY RD
GARFIELD HEIGHTS OH
44125-2546
US

IV. Provider business mailing address

2827 OAK PARK AVE
CLEVELAND OH
44109-5433
US

V. Phone/Fax

Practice location:
  • Phone: 216-633-1334
  • Fax:
Mailing address:
  • Phone: 216-215-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number181259
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: