Healthcare Provider Details

I. General information

NPI: 1669001533
Provider Name (Legal Business Name): HANNAH HEJDUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 12/30/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2785 SOM CENTER RD
WILLOUGHBY HILLS OH
44094-6501
US

IV. Provider business mailing address

12041 RAVENNA RD
CHARDON OH
44024-7008
US

V. Phone/Fax

Practice location:
  • Phone: 216-278-0288
  • Fax:
Mailing address:
  • Phone: 239-989-7687
  • Fax: 440-286-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: