Healthcare Provider Details

I. General information

NPI: 1720965866
Provider Name (Legal Business Name): TODD STEVEN SPECKHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 WARRENSVILLE CENTER RD
SHAKER HEIGHTS OH
44122-5203
US

IV. Provider business mailing address

10900 EUCLID AVE
CLEVELAND OH
44106-1712
US

V. Phone/Fax

Practice location:
  • Phone: 216-983-4899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2504552-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.2504552-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: