Healthcare Provider Details

I. General information

NPI: 1083518864
Provider Name (Legal Business Name): MISS JULIE ANN FADENHOLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13883 DRAKE RD
STRONGSVILLE OH
44136-7900
US

IV. Provider business mailing address

21 VISTA CIR # 39A
NORTH OLMSTED OH
44070-5705
US

V. Phone/Fax

Practice location:
  • Phone: 440-571-7140
  • Fax:
Mailing address:
  • Phone: 216-401-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01790
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: