Healthcare Provider Details

I. General information

NPI: 1114693454
Provider Name (Legal Business Name): STEPHANIE TRAINER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 MEDINA RD STE 108
MEDINA OH
44256-9801
US

IV. Provider business mailing address

1300 GRANT DR
PARMA OH
44134-5327
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-2240
  • Fax:
Mailing address:
  • Phone: 216-299-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: