Healthcare Provider Details

I. General information

NPI: 1063341915
Provider Name (Legal Business Name): MRS. PATRICIA DEJOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28890 CHARDON RD
WILLOUGHBY HILLS OH
44092-2614
US

IV. Provider business mailing address

28890 CHARDON RD
WILLOUGHBY HILLS OH
44092-2614
US

V. Phone/Fax

Practice location:
  • Phone: 440-278-7103
  • Fax:
Mailing address:
  • Phone: 440-278-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: