Healthcare Provider Details

I. General information

NPI: 1205752383
Provider Name (Legal Business Name): MRS. LAQUISHA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAQUISHA JONES MARRIED

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 AVONDALE RD
SOUTH EUCLID OH
44121-2927
US

IV. Provider business mailing address

1216 AVONDALE RD
SOUTH EUCLID OH
44121-2927
US

V. Phone/Fax

Practice location:
  • Phone: 216-952-4435
  • Fax:
Mailing address:
  • Phone: 216-952-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number1824735
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: