Healthcare Provider Details

I. General information

NPI: 1063430908
Provider Name (Legal Business Name): KATHLEEN SAXER-TISDALE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 N ABBE RD SUITE 1
SHEFFIELD VILLAGE OH
44035-1451
US

IV. Provider business mailing address

2525 E 22ND ST
CLEVELAND OH
44115-3202
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-9930
  • Fax: 440-934-9645
Mailing address:
  • Phone: 216-459-9827
  • Fax: 216-696-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0003132
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: