Healthcare Provider Details

I. General information

NPI: 1033811138
Provider Name (Legal Business Name): PATRICIA LANDON KUIVINEN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 ROCKSIDE RD STE 135
INDEPENDENCE OH
44131-2171
US

IV. Provider business mailing address

12200 FAIRHILL RD STE E193
CLEVELAND OH
44120-1058
US

V. Phone/Fax

Practice location:
  • Phone: 330-518-8334
  • Fax:
Mailing address:
  • Phone: 216-325-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS.0017354
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: