Healthcare Provider Details

I. General information

NPI: 1073461091
Provider Name (Legal Business Name): JOCELYN GARDNER SWT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30841 EUCLID AVE STE 103
WILLOUGHBY OH
44094-3100
US

IV. Provider business mailing address

30841 EUCLID AVE STE 103
WILLOUGHBY OH
44094-3100
US

V. Phone/Fax

Practice location:
  • Phone: 216-441-2496
  • Fax:
Mailing address:
  • Phone: 216-441-2496
  • Fax: 216-634-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS.264837-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: