Healthcare Provider Details

I. General information

NPI: 1265196877
Provider Name (Legal Business Name): KATELYN STANTON MCCLURE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 RIDGE RD
PARMA OH
44129-3936
US

IV. Provider business mailing address

5955 RIDGE RD
PARMA OH
44129-3936
US

V. Phone/Fax

Practice location:
  • Phone: 440-888-0300
  • Fax: 317-520-8200
Mailing address:
  • Phone: 440-888-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2410953
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-190723
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: