Healthcare Provider Details

I. General information

NPI: 1306706346
Provider Name (Legal Business Name): TANISHA JAMISON AA.CDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 MAYFIELD RD
LYNDHURST OH
44124-2405
US

IV. Provider business mailing address

628 CHARLES PL
HIGHLAND HEIGHTS OH
44143-1948
US

V. Phone/Fax

Practice location:
  • Phone: 440-488-7341
  • Fax: 440-683-4227
Mailing address:
  • Phone: 440-488-7341
  • Fax: 440-488-7341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: