Healthcare Provider Details

I. General information

NPI: 1881491496
Provider Name (Legal Business Name): MAKENA WALDRON CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 PEARL RD STE 200
STRONGSVILLE OH
44136-3356
US

IV. Provider business mailing address

14109 CLIFFORD AVE
CLEVELAND OH
44135-1415
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax:
Mailing address:
  • Phone: 330-988-5962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608385
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: