Healthcare Provider Details

I. General information

NPI: 1245256601
Provider Name (Legal Business Name): PAUL G. MONKOWSKI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5564 WILSON MILLS RD STE 201
HIGHLAND HTS OH
44143-3265
US

IV. Provider business mailing address

5564 WILSON MILLS RD STE 201
HIGHLAND HTS OH
44143-3265
US

V. Phone/Fax

Practice location:
  • Phone: 440-461-1255
  • Fax:
Mailing address:
  • Phone: 440-461-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number198
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: