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General NPI Number Information
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NPI Number | 1225120975
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Entity Type | Individual
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Provider Name | DR. LORI ANN STEVIC-RUST
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4132 ERIE ST STE 208
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City | WILLOUGHBY
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State | OH
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Zip | 44094-7855
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Country | US
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Telephone | 440-946-7796
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Fax |
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Provider Business Mailing Address
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Address Line | 9305 FRASER LN
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City | CHESTERLAND
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State | OH
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Zip | 44026-3584
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Country | US
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Telephone | 216-469-2160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 4441
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License Number State | OH
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